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Re: Flu shoots
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Diane Smith
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Oct 29, 2009 17:42 PST
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I have come to learn, my mom used to do the exact same thing. She did
home dialysis back in the 60's and if she ate some special food that
she could not have, or that she knew she should not eat, she would
just come and dialyze. Opps!
~Diane
On Oct 29, 2009, at 12:19 PM, jcro-@aol.com wrote:
| | I completely understand. I did the same after the surgery for a
couple of weeks.
Diane, close your eyes you are not supposed to read this bad
behavior on our part.......ha ha ha
Rgds,
JC
In a message dated 10/29/2009 4:41:20 P.M. Eastern Daylight Time, richard.w-@disney.com
writes:
Yeah I kind of had a party eating all the foods I couldn’t have
before the surgery.
From:
aaaj1vkjp_mcqems8zh4w1z-@boing.topica.com
[mailto
:aaaj1vkjp_mcqems8zh4w1z-@boing.topica.com] On
Behalf Of jcro-@aol.com
Sent: Wednesday, October 28, 2009 6:23 PM
To: pk-@topica.com
Subject: Re: PKD-PLD Flu shoots
I am glad to hear that. I had the opposite happened. I lost 24
pounds after surgery but now a year and four months later I have
gained it all back. It is all food and all my fault so I am back
exercising and eating right again.
Rgds,
JC
In a message dated 10/28/2009 2:19:41 P.M. Eastern Daylight Time, richard.w-@disney.com
writes:
So far so good. I woke up from surgery feeling better than I did
when I went under. I did gain about twenty pounds, but now that I’m
back at work and a more normal activity level I seem to be losing
it. Probably from taking the stairs instead of the elevator. They
told me to stay out of crowded elevators.
From:
aaaj1vkjp_mcqems8zh4w1z-@boing.topica.com
[mailto
:aaaj1vkjp_mcqems8zh4w1z-@boing.topica.com] On
Behalf Of jcro-@aol.com
Sent: Wednesday, October 28, 2009 11:01 AM
To: pk-@topica.com
Subject: Re: PKD-PLD Flu shoots
Mine is one year and four months now. How is everything going with
your transplant?
Rgds,
JC
Sent via BlackBerry by AT&T
From: "Edwards, Richard W" <richard.w-@disney.com>
Date: Wed, 28 Oct 2009 17:09:56 +0000
To: <pk-@topica.com>
Subject: RE: PKD-PLD Flu shoots
I contacted the UCLA transplant center and was instructed not to get
a flu shot until 6 months after my transplant. I had my transplant
in July so…..
From:
aaaj1vkjp_mcqems8zh4w1z-@boing.topica.com
[mailto
:aaaj1vkjp_mcqems8zh4w1z-@boing.topica.com] On
Behalf Of jcro-@aol.com
Sent: Wednesday, October 28, 2009 6:36 AM
To: pk-@topica.com
Subject: Re: PKD-PLD Flu shoots
Dear Diane,
Thank you very much for the information. Is anyone here getting the
H1N1 vaccine? I am still on the fence on this one. My transplant
center and Nephrologist urged me to get it but I am not rushing to
do it just yet. I spoke with a co-worker of mine, who is also a
transplant recipient, and she is also undecided. As ER nurses we
are given both the flu and H1N1 for free. I always get the flu vac
but I am being more cautious about H1N1. Although, it is
manufactured by the same maker of the flu vaccine and made new every
year I still I get a little apprehensive because of it being so
"new" and due my post-transplant status.
Rgds,
JC
In a message dated 10/26/2009 12:11:32 P.M. Eastern Daylight Time, Dia-@pkdiet.com
writes:
Here is something about heart lung transplantees and to be
especially cautious:
H1N1 Flu Challenges Heart and Lung Transplants
By Michael Smith, North American Correspondent, MedPage Today
Published: October 23, 2009
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of
Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
The pandemic H1N1 flu poses special problems for people getting
heart and lung transplants, according to an advisory from the
International Society for Heart and Lung Transplantation.
The pandemic virus "highlights unique aspects of transplant care
that will require heightened vigilance in coming months," according
to Lara Danziger-Isakov, MD, of the Cleveland Clinic Children's
Hospital, and colleagues.
"Aggressive diagnosis and early treatment" will need to be paired
with active preventive measures to lessen the impact of the pandemic
on the transplant population, she and colleagues wrote online in the
Journal of Heart and Lung Transplantation.
Among the key elements:
1. Transplant patients should get both the seasonal trivalent
inactivated flu vaccine and the H1N1 vaccine as soon as possible.
2. Avoid using live, attenuated seasonal trivalent vaccine
(FluMist nasal spray) with transplant candidates and recipients, as
well as their care providers.
3. Both seasonal and flu vaccines can be given soon after
transplant, but caregivers should be aware that vaccination soon
after transplantation may only be partly protective.
4. Potential donors should have nasopharyngeal and throat
swabs for the H1N1 virus before the organs are harvested.
5. The preferred test for all flu infections, including the
pandemic virus, is real-time reverse transcriptase-polymerase chain
reaction (rRT-PCR).
6. A negative result on a rapid influenza detection assay does
not exclude diagnosis of pandemic flu infection.
The turnaround time for rRT-PCR is up to 48 hours, plus travel time
in some cases, the researchers said.
Especially when it comes to evaluating donors -- where time is of
the essence -- the long turnaround is "a concern" and highlights the
need for faster tests, they said.
Aside from vaccination, Danziger-Isakov and colleagues said,
caregivers can also consider postexposure prophylaxis and prolonged
seasonal prophylaxis, both with oseltamivir (Tamiflu).
In the case of prolonged prophylaxis, caregivers should be aware
that oseltamivir resistance in the H1N1 flu is rare, but cases have
been identified, many in immunocompromised patients.
If a potential donor dies of confirmed H1N1 flu, Danziger-Isakov and
colleagues said, neither the lungs nor heart should be used for
transplantation.
In some cases, a donor with confirmed H1N1 flu might die of another
cause, they said. In those cases, the lungs should not be used, but
the heart may be, at the discretion of the transplanting medical team.
The same is true for potential donors with suspect cases of the
pandemic flu, they said.
On the other hand, both the lungs and heart of a donor with a
history of the H1N1 flu who received at least five days of treatment
can be used, they said.
http://www.topica.com/?p=TEXFOOTER
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<html><head></head><body style="word-wrap: break-word; -webkit-nbsp-mode: space; -webkit-line-break: after-white-space; ">I have come to learn, my mom used to do the exact same thing. She did home dialysis back in the 60's and if she ate some special food that she could not have, or that she knew she should not eat, she would just come and dialyze. Opps!<div><br></div><div>~Diane</div><div><br></div><div><br><div><div>On Oct 29, 2009, at 12:19 PM, <a href="mailto:jcro-@aol.com">jcro-@aol.com</a> wrote:</div><br class="Apple-interchange-newline"><blockquote type="cite">
<div style="FONT-FAMILY: Arial; COLOR: #000000; FONT-SIZE: 10pt" id="role_body" bottommargin="7" leftmargin="7" rightmargin="7" topmargin="7"><font id="role_document" color="#000000" size="2" face="Arial">
<div>
<div>I completely understand. I did the same after the surgery for a
couple of weeks. </div>
<div>Diane, close your eyes you are not supposed to read this bad behavior on
our part.......ha ha ha</div>
<div> </div>
<div>Rgds,</div>
<div> </div>
<div>JC</div>
<div> </div>
<div> </div>
<div>In a message dated 10/29/2009 4:41:20 P.M. Eastern Daylight Time,
<a href="mailto:richard.w-@disney.com">richard.w-@disney.com</a> writes:</div>
<blockquote style="BORDER-LEFT: blue 2px solid; PADDING-LEFT: 5px; MARGIN-LEFT: 5px"><font style="BACKGROUND-COLOR: transparent" color="#000000" size="2" face="Arial">
<div class="Section1"><p class="MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: navy; FONT-SIZE: 10pt">Yeah I kind of had a
party eating all the foods I couldn’t have before the
surgery.<o:p></o:p></span></font></p><p class="MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: navy; FONT-SIZE: 10pt"><o:p> </o:p></span></font></p>
<div>
<div style="TEXT-ALIGN: center" class="MsoNormal" align="center"><font size="3" face="Times New Roman"><span style="FONT-SIZE: 12pt">
<hr tabindex="-1" align="center" size="2" width="100%">
</span></font></div><p class="MsoNormal"><b><font size="2" face="Tahoma"><span style="FONT-FAMILY: Tahoma; FONT-SIZE: 10pt; FONT-WEIGHT: bold">From:</span></font></b><font size="2" face="Tahoma"><span style="FONT-FAMILY: Tahoma; FONT-SIZE: 10pt">
<a href="mailto:aaaj1vkjp_mcqems8zh4w1z-@boing.topica.com">aaaj1vkjp_mcqems8zh4w1z-@boing.topica.com</a>
[mailto:aaaj1vkjp_mcqems8zh4w1z-@boing.topica.com]
<b><span style="FONT-WEIGHT: bold">On Behalf Of
</span></b><a href="mailto:jcro-@aol.com">jcro-@aol.com</a><br><b><span style="FONT-WEIGHT: bold">Sent:</span></b> Wednesday, October 28, 2009 6:23
PM<br><b><span style="FONT-WEIGHT: bold">To:</span></b> <st1:personname w:st="on">pk-@topica.com</st1:personname><br><b><span style="FONT-WEIGHT: bold">Subject:</span></b> Re: PKD-PLD Flu
shoots</span></font><o:p></o:p></p></div><p class="MsoNormal"><font size="3" face="Times New Roman"><span style="FONT-SIZE: 12pt"><o:p> </o:p></span></font></p>
<div>
<div><p class="MsoNormal"><font color="black" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 10pt">I am glad to hear
that. I had the opposite happened. I lost 24 pounds after surgery
but now a year and four months later I have gained it all back. It is
all food and all my fault so I am back exercising and eating right
again.<o:p></o:p></span></font></p></div>
<div><p class="MsoNormal"><font color="black" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 10pt"> <o:p></o:p></span></font></p></div>
<div><p class="MsoNormal"><font color="black" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 10pt">Rgds,<o:p></o:p></span></font></p></div>
<div><p class="MsoNormal"><font color="black" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 10pt"> <o:p></o:p></span></font></p></div>
<div><p class="MsoNormal"><font color="black" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 10pt">JC<o:p></o:p></span></font></p></div>
<div><p class="MsoNormal"><font color="black" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 10pt"> <o:p></o:p></span></font></p></div>
<div><p class="MsoNormal"><font color="black" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 10pt">In a message dated
10/28/2009 2:19:41 P.M. Eastern Daylight Time, <a href="mailto:richard.w-@disney.com">richard.w-@disney.com</a>
writes:<o:p></o:p></span></font></p></div>
<blockquote style="BORDER-BOTTOM: medium none; BORDER-LEFT: blue 1.5pt solid; PADDING-BOTTOM: 0in; MARGIN-TOP: 5pt; PADDING-LEFT: 4pt; PADDING-RIGHT: 0in; MARGIN-BOTTOM: 5pt; MARGIN-LEFT: 3.75pt; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0in"><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: navy; FONT-SIZE: 10pt">So far so
good. I woke up from surgery feeling better than I did when I went
under. I did gain about twenty pounds, but now that I’m back at work
and a more normal activity level I seem to be losing it. Probably from
taking the stairs instead of the elevator. They told me to stay out of
crowded elevators.<o:p></o:p></span></font></p><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: navy; FONT-SIZE: 10pt"><o:p> </o:p></span></font></p>
<div>
<div style="TEXT-ALIGN: center" class="MsoNormal" align="center"><font color="black" size="3" face="Times New Roman"><span style="COLOR: black; FONT-SIZE: 12pt">
<hr tabindex="-1" align="center" size="2" width="100%">
</span></font></div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><b><font color="black" size="2" face="Tahoma"><span style="FONT-FAMILY: Tahoma; COLOR: black; FONT-SIZE: 10pt; FONT-WEIGHT: bold">From:</span></font></b><font color="black" size="2" face="Tahoma"><span style="FONT-FAMILY: Tahoma; COLOR: black; FONT-SIZE: 10pt">
<a href="mailto:aaaj1vkjp_mcqems8zh4w1z-@boing.topica.com">aaaj1vkjp_mcqems8zh4w1z-@boing.topica.com</a>
[mailto:aaaj1vkjp_mcqems8zh4w1z-@boing.topica.com]
<b><span style="FONT-WEIGHT: bold">On Behalf Of
</span></b><a href="mailto:jcro-@aol.com">jcro-@aol.com</a><br><b><span style="FONT-WEIGHT: bold">Sent:</span></b> Wednesday, October 28, 2009 11:01
AM<br><b><span style="FONT-WEIGHT: bold">To:</span></b> </span></font><font size="2" face="Tahoma"><span style="FONT-FAMILY: Tahoma; FONT-SIZE: 10pt"><ns0:personname w:insauthor="Unknown" w:insdate="2009-10-29T13:38:00Z" w:endinsauthor="Unknown" w:endinsdate="2009-10-29T13:38:00Z"><st1:personname w:st="on"><font color="black"><span style="COLOR: black"><a href="mailto:pk-@topica.com">pk-@topica.com</a></span></font></st1:personname></ns0:personname><font color="black"><span style="COLOR: black"><br><b><span style="FONT-WEIGHT: bold">Subject:</span></b> Re: PKD-PLD Flu
shoots</span></font></span></font><font color="black"><span style="COLOR: black"><o:p></o:p></span></font></p></div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR: black; FONT-SIZE: 12pt"><o:p> </o:p></span></font></p><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR: black; FONT-SIZE: 12pt">Mine is one year and four months now.
How is everything going with your
transplant?<br><br>Rgds,<br>JC<o:p></o:p></span></font></p><p><font color="black" size="3" face="Times New Roman"><span style="COLOR: black; FONT-SIZE: 12pt">Sent via BlackBerry by
AT&T<o:p></o:p></span></font></p>
<div style="TEXT-ALIGN: center" class="MsoNormal" align="center"><font color="black" size="3" face="Times New Roman"><span style="COLOR: black; FONT-SIZE: 12pt">
<hr align="center" size="2" width="100%">
</span></font></div>
<div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><b><font color="black" size="3" face="Times New Roman"><span style="COLOR: black; FONT-SIZE: 12pt; FONT-WEIGHT: bold">From:
</span></font></b><font color="black"><span style="COLOR: black">"Edwards,
Richard W" <<a href="mailto:richard.w-@disney.com">richard.w-@disney.com</a>>
<o:p></o:p></span></font></p></div>
<div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><b><font color="black" size="3" face="Times New Roman"><span style="COLOR: black; FONT-SIZE: 12pt; FONT-WEIGHT: bold">Date:
</span></font></b><font color="black"><span style="COLOR: black">Wed, 28 Oct
2009 17:09:56 +0000<o:p></o:p></span></font></p></div>
<div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><b><font color="black" size="3" face="Times New Roman"><span style="COLOR: black; FONT-SIZE: 12pt; FONT-WEIGHT: bold">To:
</span></font></b><font color="black"><span style="COLOR: black"><</span></font><ns0:personname w:insauthor="Unknown" w:insdate="2009-10-29T13:38:00Z" w:endinsauthor="Unknown" w:endinsdate="2009-10-29T13:38:00Z"><st1:personname w:st="on"><font color="black"><span style="COLOR: black"><a href="mailto:pk-@topica.com">pk-@topica.com</a></span></font></st1:personname></ns0:personname><font color="black"><span style="COLOR: black">><o:p></o:p></span></font></p></div>
<div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><b><font color="black" size="3" face="Times New Roman"><span style="COLOR: black; FONT-SIZE: 12pt; FONT-WEIGHT: bold">Subject:
</span></font></b><font color="black"><span style="COLOR: black">RE: PKD-PLD
Flu shoots<o:p></o:p></span></font></p></div>
<div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR: black; FONT-SIZE: 12pt"><o:p> </o:p></span></font></p></div>
<div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: navy; FONT-SIZE: 10pt">I contacted the
UCLA transplant center and was instructed not to get a flu shot until 6
months after my transplant. I had my transplant in July
so…..<o:p></o:p></span></font></p><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="navy" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: navy; FONT-SIZE: 10pt"><o:p> </o:p></span></font></p>
<div>
<div style="TEXT-ALIGN: center" class="MsoNormal" align="center"><font color="black" size="3" face="Times New Roman"><span style="COLOR: black; FONT-SIZE: 12pt">
<hr tabindex="-1" align="center" size="2" width="100%">
</span></font></div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><b><font color="black" size="2" face="Tahoma"><span style="FONT-FAMILY: Tahoma; COLOR: black; FONT-SIZE: 10pt; FONT-WEIGHT: bold">From:</span></font></b><font color="black" size="2" face="Tahoma"><span style="FONT-FAMILY: Tahoma; COLOR: black; FONT-SIZE: 10pt">
<a href="mailto:aaaj1vkjp_mcqems8zh4w1z-@boing.topica.com">aaaj1vkjp_mcqems8zh4w1z-@boing.topica.com</a>
[mailto:aaaj1vkjp_mcqems8zh4w1z-@boing.topica.com]
<b><span style="FONT-WEIGHT: bold">On Behalf Of
</span></b><a href="mailto:jcro-@aol.com">jcro-@aol.com</a><br><b><span style="FONT-WEIGHT: bold">Sent:</span></b> Wednesday, October 28, 2009 6:36
AM<br><b><span style="FONT-WEIGHT: bold">To:</span></b> </span></font><font size="2" face="Tahoma"><span style="FONT-FAMILY: Tahoma; FONT-SIZE: 10pt"><ns0:personname w:insauthor="Unknown" w:insdate="2009-10-29T13:38:00Z" w:endinsauthor="Unknown" w:endinsdate="2009-10-29T13:38:00Z"><st1:personname w:st="on"><font color="black"><span style="COLOR: black"><a href="mailto:pk-@topica.com">pk-@topica.com</a></span></font></st1:personname></ns0:personname><font color="black"><span style="COLOR: black"><br><b><span style="FONT-WEIGHT: bold">Subject:</span></b> Re: PKD-PLD Flu
shoots</span></font></span></font><font color="black"><span style="COLOR: black"><o:p></o:p></span></font></p></div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="black" size="3" face="Times New Roman"><span style="COLOR: black; FONT-SIZE: 12pt"><o:p> </o:p></span></font></p>
<div>
<div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="black" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 10pt">Dear
Diane,<o:p></o:p></span></font></p></div>
<div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="black" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 10pt"> <o:p></o:p></span></font></p></div>
<div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="black" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 10pt">Thank you very
much for the information. Is anyone here getting the H1N1
vaccine? I am still on the fence on this one. My transplant
center and Nephrologist urged me to get it but I am not rushing to do it
just yet. I spoke with a co-worker of mine, who is also
a transplant recipient, and she is also undecided. As ER nurses
we are given both the flu and H1N1 for free. I always get the flu
vac but I am being more cautious about H1N1. Although, it is
manufactured by the same maker of the flu vaccine and made new every year I
still I get a little apprehensive because of it being so "new" and due
my post-transplant status.<o:p></o:p></span></font></p></div>
<div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="black" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 10pt"> <o:p></o:p></span></font></p></div>
<div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="black" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 10pt"> <o:p></o:p></span></font></p></div>
<div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="black" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 10pt">Rgds,<o:p></o:p></span></font></p></div>
<div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="black" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 10pt"> <o:p></o:p></span></font></p></div>
<div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="black" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 10pt">JC<o:p></o:p></span></font></p></div>
<div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="black" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 10pt"> <o:p></o:p></span></font></p></div>
<div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="black" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 10pt"> <o:p></o:p></span></font></p></div>
<div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="black" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 10pt"> <o:p></o:p></span></font></p></div>
<div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="black" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 10pt">In a message dated
10/26/2009 12:11:32 P.M. Eastern Daylight Time, <a href="mailto:Dia-@pkdiet.com">Dia-@pkdiet.com</a>
writes:<o:p></o:p></span></font></p></div>
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<div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="black" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 10pt">Here is
something about heart lung transplantees and to be especially
cautious:<o:p></o:p></span></font></p></div>
<div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="black" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 10pt"><o:p> </o:p></span></font></p></div>
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<h1><b><font color="#003399" size="4" face="Georgia"><span style="FONT-FAMILY: Georgia; COLOR: #003399; FONT-SIZE: 14.5pt">H1N1
Flu Challenges Heart and Lung
Transplants<o:p></o:p></span></font></b></h1></td></tr>
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<td style="PADDING-BOTTOM: 3.75pt; PADDING-LEFT: 0in; PADDING-RIGHT: 0in; PADDING-TOP: 3.75pt"><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="black" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 8.5pt">By Michael
Smith, North American Correspondent, MedPage
Today<br></span></font><font color="#666666" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #666666; FONT-SIZE: 8.5pt">Published:
October 23, 2009</span></font><font color="black" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 8.5pt"><br>Reviewed by <a title="http://www.medpagetoday.com/reviewer.cfm?reviewerid=55" href="http://www.medpagetoday.com/reviewer.cfm?reviewerid=55"><font color="#000099" size="1"><span style="COLOR: #000099; FONT-SIZE: 9pt; TEXT-DECORATION: none">Robert
Jasmer, MD</span></font></a>; Associate Clinical
Professor of Medicine, </span></font><font size="1" face="Arial"><span style="FONT-FAMILY: Arial; FONT-SIZE: 8.5pt"><ns0:placetype w:insauthor="Unknown" w:insdate="2009-10-29T13:38:00Z" w:endinsauthor="Unknown" w:endinsdate="2009-10-29T13:38:00Z"><st1:placetype w:st="on"><font color="black"><span style="COLOR: black">University</span></font></st1:placetype></ns0:placetype><font color="black"><span style="COLOR: black"> of
</span></font><ns0:placename w:insauthor="Unknown" w:insdate="2009-10-29T13:38:00Z" w:endinsauthor="Unknown" w:endinsdate="2009-10-29T13:38:00Z"><st1:placename w:st="on"><font color="black"><span style="COLOR: black">California</span></font></st1:placename></ns0:placename><font color="black"><span style="COLOR: black">,
</span></font><ns0:place w:insauthor="Unknown" w:insdate="2009-10-29T13:38:00Z" w:endinsauthor="Unknown" w:endinsdate="2009-10-29T13:38:00Z"><ns0:city w:insauthor="Unknown" w:insdate="2009-10-29T13:38:00Z" w:endinsauthor="Unknown" w:endinsdate="2009-10-29T13:38:00Z"><st1:city w:st="on"><st1:place w:st="on"><font color="black"><span style="COLOR: black">San
Francisco</span></font></st1:place></st1:city></ns0:city></ns0:place><font color="black"><span style="COLOR: black"> and<br>Dorothy
Caputo, MA, RN, BC-ADM, CDE, Nurse
Planner</span></font></span></font><font size="1"><span style="FONT-SIZE: 8.5pt"><o:p></o:p></span></font></p></td>
<td style="PADDING-BOTTOM: 0.75pt; PADDING-LEFT: 0.75pt; PADDING-RIGHT: 0.75pt; PADDING-TOP: 3.75pt"><p style="TEXT-ALIGN: right; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal" align="right"><font size="1" face="Times New Roman"><span style="FONT-SIZE: 8.5pt"><a style="tex: none" title="http://www.medpagetoday.com/posttest.cfm?testpage=16582&;TBID=16582&topicid=30" href="http://www.medpagetoday.com/posttest.cfm?testpage=16582&TBID=16582&topicid=30"></a><o:p></o:p></span></font></p></td></tr></tbody></table><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font size="1" face="Times New Roman"><span style="FONT-SIZE: 8.5pt"><o:p></o:p></span></font></p></td></tr>
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<div><p style="LINE-HEIGHT: 11.25pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">The
pandemic H1N1 flu poses special problems for people getting
heart and lung transplants, according to an advisory from the
International Society for Heart and Lung Transplantation.
<o:p></o:p></span></font></p>
<div><p style="LINE-HEIGHT: 11.25pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt"><o:p> </o:p></span></font></p></div><p style="LINE-HEIGHT: 11.25pt"><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">The
pandemic virus "highlights unique aspects of transplant care
that will require heightened vigilance in coming months,"
according to Lara Danziger-Isakov, MD, of the Cleveland Clinic
Children's Hospital, and
colleagues.<o:p></o:p></span></font></p><p style="LINE-HEIGHT: 11.25pt"><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">"Aggressive
diagnosis and early treatment" will need to be paired with
active preventive measures to lessen the impact of the
pandemic on the transplant population, she and colleagues
wrote online in the <em><i><font face="Arial"><span style="FONT-FAMILY: Arial">Journal of Heart and Lung
Transplantation</span></font></i></em>.<o:p></o:p></span></font></p><p style="LINE-HEIGHT: 11.25pt"><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">Among
the key elements:<o:p></o:p></span></font></p><p style="LINE-HEIGHT: 11.25pt; TEXT-INDENT: -0.25in; MARGIN-LEFT: 0.5in; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">1.</span></font><font color="#151515" size="1"><span style="COLOR: #151515; FONT-SIZE: 7pt">
</span></font><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">Transplant
patients should get both the seasonal trivalent inactivated
flu vaccine and the H1N1 vaccine as soon as possible.
<o:p></o:p></span></font></p><p style="LINE-HEIGHT: 11.25pt; TEXT-INDENT: -0.25in; MARGIN-LEFT: 0.5in; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">2.</span></font><font color="#151515" size="1"><span style="COLOR: #151515; FONT-SIZE: 7pt">
</span></font><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">Avoid
using live, attenuated seasonal trivalent vaccine (FluMist
nasal spray) with transplant candidates and recipients, as
well as their care providers. <o:p></o:p></span></font></p><p style="LINE-HEIGHT: 11.25pt; TEXT-INDENT: -0.25in; MARGIN-LEFT: 0.5in; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">3.</span></font><font color="#151515" size="1"><span style="COLOR: #151515; FONT-SIZE: 7pt">
</span></font><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">Both
seasonal and flu vaccines can be given soon after transplant,
but caregivers should be aware that vaccination soon after
transplantation may only be partly protective.
<o:p></o:p></span></font></p><p style="LINE-HEIGHT: 11.25pt; TEXT-INDENT: -0.25in; MARGIN-LEFT: 0.5in; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">4.</span></font><font color="#151515" size="1"><span style="COLOR: #151515; FONT-SIZE: 7pt">
</span></font><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">Potential
donors should have nasopharyngeal and throat swabs for the
H1N1 virus before the organs are harvested.
<o:p></o:p></span></font></p><p style="LINE-HEIGHT: 11.25pt; TEXT-INDENT: -0.25in; MARGIN-LEFT: 0.5in; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">5.</span></font><font color="#151515" size="1"><span style="COLOR: #151515; FONT-SIZE: 7pt">
</span></font><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">The
preferred test for all flu infections, including the pandemic
virus, is real-time reverse transcriptase-polymerase chain
reaction (rRT-PCR). <o:p></o:p></span></font></p><p style="LINE-HEIGHT: 11.25pt; TEXT-INDENT: -0.25in; MARGIN-LEFT: 0.5in; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">6.</span></font><font color="#151515" size="1"><span style="COLOR: #151515; FONT-SIZE: 7pt">
</span></font><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">A
negative result on a rapid influenza detection assay does not
exclude diagnosis of pandemic flu
infection.<o:p></o:p></span></font></p>
<div><p style="LINE-HEIGHT: 11.25pt; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt"><o:p> </o:p></span></font></p></div><p style="LINE-HEIGHT: 11.25pt"><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">The
turnaround time for rRT-PCR is up to 48 hours, plus travel
time in some cases, the researchers
said.<o:p></o:p></span></font></p><p style="LINE-HEIGHT: 11.25pt"><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">Especially
when it comes to evaluating donors -- where time is of the
essence -- the long turnaround is "a concern" and highlights
the need for faster tests, they
said.<o:p></o:p></span></font></p><p style="LINE-HEIGHT: 11.25pt"><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">Aside
from vaccination, Danziger-Isakov and colleagues said,
caregivers can also consider postexposure prophylaxis and
prolonged seasonal prophylaxis, both with oseltamivir
(Tamiflu).<o:p></o:p></span></font></p><p style="LINE-HEIGHT: 11.25pt"><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">In
the case of prolonged prophylaxis, caregivers should be aware
that oseltamivir resistance in the H1N1 flu is rare, but cases
have been identified, many in immunocompromised
patients.<o:p></o:p></span></font></p><p style="LINE-HEIGHT: 11.25pt"><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">If
a potential donor dies of confirmed H1N1 flu, Danziger-Isakov
and colleagues said, neither the lungs nor heart should be
used for transplantation.<o:p></o:p></span></font></p><p style="LINE-HEIGHT: 11.25pt"><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">In
some cases, a donor with confirmed H1N1 flu might die of
another cause, they said. In those cases, the lungs should not
be used, but the heart may be, at the discretion of the
transplanting medical team.<o:p></o:p></span></font></p><p style="LINE-HEIGHT: 11.25pt"><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">The
same is true for potential donors with suspect cases of the
pandemic flu, they said.<o:p></o:p></span></font></p><p style="LINE-HEIGHT: 11.25pt"><font color="#151515" size="1" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: #151515; FONT-SIZE: 9pt">On
the other hand, both the lungs and heart of a donor with a
history of the H1N1 flu who received at least five days of
treatment can be used, they
said.<o:p></o:p></span></font></p></div></td></tr></tbody></table></div><p style="mso-margin-top-alt: auto; mso-margin-bottom-alt: auto" class="MsoNormal"><font size="1" face="Times New Roman"><span style="FONT-SIZE: 8.5pt"><o:p></o:p></span></font></p></td></tr></tbody></table></div></div></div></blockquote></div></div></blockquote></div>
<div><p class="MsoNormal"><font color="black" size="2" face="Arial"><span style="FONT-FAMILY: Arial; COLOR: black; FONT-SIZE: 10pt"> <o:p></o:p></span></font></p></div><pre><font color="black" size="2" face="Courier New"><span style="FONT-SIZE: 10pt; PRE: jcro-@aol.com
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