Tag Archives: flu

Getting Flu Shot a Great Investment in Your Health

Dr. Donald Bucklin

Dr. Donald Bucklin

When discussing the flu, “same old-same old” means over 40,000 people will die in this country of the flu this winter.

That’s as many people as will likely get killed on U.S. highways this year. It would be nice to vaccinate against getting killed in a car crash, wouldn’t it?

This influenza season is a particularly severe one, if present trends hold out. Most of the deaths will occur in the very old or very young, both of which are not easily vaccinated, because they can‘t drive or ask for the vaccine. They depend on us able-bodied people, known as “the herd” in public health vernacular.

The herd can dramatically influence the spread of disease like influenza. Part of this herd is the workers at an institution that care for the elderly, the sick or the very young. They pass in and out of the institution every day, sometimes bringing and sometimes taking home unwanted viral baggage.

The flu depends on finding its next susceptible victim to continue its relentless winter march.

We all briefly consider getting a flu shot each winter, according to our own private equation. We consider the media headlines, our health, our experience with the flu vaccine or the flu, and weigh in the cost of the vaccine in time and money.

This may all be largely subconscious, but ultimately pushes us toward or away from the vaccination opportunities. You either stop and do it or drive by. The health care providers of the world are grinding their teeth in frustration trying to influence your decision.

Medical types like to place every illness under the microscope. The Canadians, common sense people that they are, tried a different approach, looking at flu from across the street. Their study didn’t even limit itself to influenza alone; they looked at winter respiratory illness in general.

The Canadian study included everything from the mildest chest cold to pneumonia, and everything in between. Influenza was part of that group.

During the study they gave the influenza vaccine to a large group and carefully observed for any respiratory illness. A more compulsive approach would be to count only lab-proven influenza, but that was not the Canadian way. Still, they generated some very interesting results.

Those who were vaccinated had 25 percent fewer respiratory illnesses than people who weren’t. The vaccinated group had 43 percent fewer sick days that winter, 44 percent fewer doctor visits, and saved almost $47 per patient.

Those are some impressive numbers and being a doctor, I very much want to do influenza antibody tests of all those Canadians. But that isn’t the point. The point is there seems to be a larger spectrum of influenza than we realize. Looking at doctor visits and sick days and all of that, a flu shot has measurable benefit for most people.

So you can get vaccinated because you are trying to keep the family healthy this winter, or because it’s the right thing to do. You can also get vaccinated simply because it’s a good investment in your health.

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic.

 

Flu Vaccine May Protect Your Heart

Every fall there is an eternal struggle between the forces of good – those who like flu vaccine – and the evil — those who avoid flu vaccine like the plague.

Public health officials and medical folks are making as much noise as possible to encourage vaccination. And it’s a noble effort because the flu is worth avoiding.

Do you remember the last time you had a 103 temperature? Did you hallucinate and have some very bad dreams and your body ached so much it felt like Mike Tyson used you for a sparring partner? And did you make a serious attempt to cough a lung out?

Spend 7-10 days feeling this horrible and you are willing to surrender and do anything to avoid it ever happening again.

Now we may have a much better reason to get the flu vaccine than even avoiding the flu. How about not having a heart attack or stroke? Think the flu is bad? Heart attacks and strokes will really ruin your day, year and life!

This revelation comes from a Canadian cardiologist names Dr. Jacob Udell. He took several studies on flu vaccine and illness and compiled them. This can be a very powerful tool to get information that was not clearly visible in the smaller individual studies. It turns out that people who received the flu vaccine had a 50 percent reduction in heart attacks and strokes. That is no less than astounding.

And my initial reaction was: This is so left-field it must be something other than a flu shot. People who get the flu shot might be a statistically unusual group of people. Maybe they smoke less, eat better or take their cholesterol medication. If that was the case, the flu shot selected a less risky group of people, rather that actually reducing heart risk.

But it looks like it actually was the flu shot that protected people from heart attack and stroke. This risk reduction occurred in both people who were healthy, and those who already had heart disease. This information also fits with some recent thinking on heart disease.

We have been looking into inflammation of blood vessels as the cause of heart attacks and stroke. Tests for inflammation are elevated in people that go on to have these vascular problems. You might remember the discussion of C-reactive protein and heart disease a few years ago. C-reactive protein is a simple blood test for inflammation; if the results are high there’s a greater chance for heart disease.

Influenza is a very inflammatory condition. Inflammation is a response to infection that is designed to help fight the infection. This inflammation can also cause trouble. Influenza is thought of as a respiratory disease, but your aching body tells you the infection is everywhere.

We have a pretty reasonable mechanism why flu vaccine would actually reduce heart attacks or strokes. A 50-percent reduction is better than we get treating elevated blood pressure or cholesterol. It is no less than a paradigm shift in thinking.

I have been vaccinated every year for flu. A week in the ICU 20 years ago taught me the flu should be avoided. If I could be guaranteed a big reduction in heart attack and stroke risk, I would get a flu shot every day!

Fortunately you need only one to avoid the flu. What are your waiting for – get your shot now!

Take care

Dr. B.

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic.

photo credit: paulswansen via photopin cc

Plenty of Good Reasons to Get the Flu Shot This Year

'Finally Got A Flu Shot $25.' photo (c) 2010, Jake Metcalf - license: http://creativecommons.org/licenses/by/2.0/
So far, it’s been a pretty uneventful flu year with no scary new strains. We picked the right flu virus to make vaccine out of, so it’s a one-shot year.

When discussing the flu, “same old-same old” means 41,000 people will die in this country of the flu this winter. That’s as many people as get killed on U.S. highways in a year. It would be nice to be able to vaccinate against automobile deaths, wouldn’t it?

Most of the flu deaths will be people 65 or older. Most of them will catch the flu from younger people around them.

We get the flu vaccine or not according to our own private equation, weighing our health, the chance of getting the flu, our memory of last winter, and the hassle factor of both illness and getting the vaccine. All this is almost unconscious, and steers us either toward or away from opportunities for vaccination. Public health folks tear their hair out trying to convince us of the benefits of herd immunity.

I recently came across some data that looked at flu vaccination from a different perspective. The study looked at respiratory illness rather than just flu. Respiratory illness includes anything that makes you congested and cough, presumably 20 dozen different cold viruses and the flu. They vaccinated a bunch of healthy working adults and watched what happened. Those vaccinated adults had 25 percent fewer respiratory illnesses, 43 percent less sick days from respiratory illness, and 44 percent fewer visits to a physician for a respiratory illness. The savings on average for each person vaccinated was almost $47.

At first glance it appears that the flu vaccine helps protect you against a bunch of cold viruses as well as influenza. That would be a heck of a flu shot – sign me up. Sadly, it doesn’t.

What it actually means is there are a bunch more cases of flu going around than anybody realizes. And the flu is a much bigger part of what makes us cough in the winter. One would suppose from this data that a third or even a half of our winter respiratory illness is flu based. Who knew?

So maybe you get vaccinated for some noble reason, like saving an elderly person’s life, or trying to keep the kids healthy this winter, or missing less work, or simply to save a buck (or $47) — it all works.

There is plenty of vaccine, and winter is coming, so what are you waiting for?

Take care,

Dr. B

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing Clinical Occupational Medicine for more than 25 years. Dr. B works in our Scottsdale, Arizona clinic.

 

Top Ten Flu Shot Myths: Don’t Fall For Them

It seems most people won’t get a flu shot this year – many turning to what can only be called the Top Ten Flu Myths. Here goes:

'Finally Got A Flu Shot $25.' photo (c) 2010, Jake Metcalf - license: http://creativecommons.org/licenses/by/2.0/

1. The flu shot can give me the flu. No way, no how. Injectable flu vaccine is 100% dead, broken-up virus – it is not infectious.

2. I won’t get the flu. That is Russian roulette. How often this winter will you be in the same room/elevator/auto with someone who is coughing, sneezing and doing their best to infect everyone? You will find yourself trapped like a rat.

3. I’m healthy, so getting the flu is no big deal. Influenza hits even the strong and healthy like a Mack Truck. Think 104 fevers and every muscle in your body screaming at you. Not much a doctor can do after you have the flu.

4. The Flu vaccine is dangerous. This is the old argument regarding the preservative Thimerosal. There is zero scientific evidence that this preservative is harmful. Given the hundreds of millions of flu shots given, even a tiny risk would be found. If you still fear this preservative, the flu vaccine is available in preservative free form (no Thimerosal) and the FluMist nasal spray has none. For the record, my children, wife and I had the regular flu vaccine (with Thimerosal).

5. Flu shots are difficult to find and useless after November. The flu season changes every year. Things like air travel spread viruses quickly to far flung places. It takes 9 days to develop immunity after being vaccinated. You will still get immunity whenever you vaccinate. In terms of finding the vaccine, the vaccine is plentiful even late in the season. If you decide a flu shot is a good idea, why risk getting the disease for months before getting a shot?

6. I get sick even if I get the flu shot. Influenza takes a couple of days to develop after you are infected. So you can also get exposed a couple of days after the vaccine, but before you are immune. Influenza vaccine doesn’t prevent colds. So any of those situations can lead people to think the vaccine didn’t work.

7. I don’t have the money. A Canadian study found an average savings of $43 in healthcare expense for every vaccinated person. Doctor visits and work absence were all significantly reduced in the vaccinated population.

8. Only old people die of flu. In normal years, 90% of flu deaths are 65 years and over. H1N1 had the opposite with almost all the deaths in the young. It is your contribution to the public good to not be passing around flu this winter. We call that herd immunity. The sum is greater than the parts.

9. I am still immune from last year’s shot. The flu vaccine is redesigned every year based on the early emerging virus types in Southeast Asia (they have their winter during our summer). When we measure immunity, flu vaccine gives very strong immunity for six months or longer. You don’t still have high antibody levels the next flu season.

10. Flu shots hurt. In my clinic, we use #30 needles that are the thickness of a human hair. The vaccine is not irritating to the muscle. There is very little pain with a carefully given flu shot. If you are needle-phobic, you can always take the nasal spray (FluMist).

We have plenty of vaccine, what are you waiting for?

Dr. B

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing Clinical Occupational Medicine for more than 25 years. Dr. B works in our Scottsdale, Arizona clinic.

What is the Flu Vaccine Anyway?

We spend a lot of time each fall talking about influenza and flu vaccine. A great deal of hard work by very smart people goes into making this magic fluid each year.

'Flu Vaccination Grippe' photo (c) 2010, Daniel Paquet - license: http://creativecommons.org/licenses/by/2.0/
The first thing you need to make flu vaccine is a flu virus. Those come in many different flavors, some old standbys trying to make a comeback, occasionally some new virus. Because the earth is tilted, our summer is the Southern Hemisphere’s winter. They are having this year’s flu season 6 months before we do. The best place to look for new influenza viruses are poor rural areas in Southeast Asia. In these areas, humans and animals frequently live close together. I’m sure you have noticed all influenza viruses have animal names (swine flu, bird flu…) – that is because the virus jumped from an animal to a person.

The World Heath Organization (WHO) is in charge of collecting flu viruses. They culture a bunch of sick people (nasal swab) to find the new and dominant viruses that season. They get pure cultures of the three worst viruses.

Now the magic begins.

Each virus is combined with a harmless standard lab virus. The result is a new virus that looks like the bad influenza virus on the outside, and like the harmless lab virus on the inside. That is important because the human body generates antibodies to the outside of the virus (it can’t see the inside). Now we have a copy of the virus that can’t make people sick, and grows well in chicken eggs. All this happens at the WHO labs.

Next it’s off to the vaccine manufacturers.

This harmless copy virus is injected into fertilized chicken eggs that are 9 to 12 days old. Three days later there are almost countless copies of the virus in the egg white. The virus is then separated from the egg white. Now it’s time to kill the virus with chemicals as we don’t want anyone being infected by this new virus (even though it is harmless). Now the virus is broken up to get a solution of the surface proteins (those on the outside).

This solution, called antigen, is then diluted to the proper concentration for use.

Next, it’s sterilized and packaged in vials and syringes.

There are hundreds of quality assurance tests done at each step of the process.

So your flu vaccine contains just the proteins from the outside of the original bad virus. It doesn’t have the ability to infect you as there is no living virus in the vaccine.

When you get your flu shot, these proteins (antigens) in the vaccine stimulate your body to make antibodies against this interloper. These antibodies will attach to the original virus and destroy it. In about 9 days you have enough antibodies to fight off an assault by the original virus.

It takes six months from finding a new virus to mass-producing the vaccine. That original virus was found in our spring (the Southern Hemisphere’s fall) and is ready for use by our fall season – just in time for flu season.

Producing the new trivalent (3 viruses) vaccine each year is one of the things the human race does very well; it requires worldwide cooperation to pull it off.

So, when you get your flu shot this year (and do it soon to maximize your protection), appreciate the “magic” that half cc of vaccine represents.

Take care

Dr B

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing Clinical Occupational Medicine for more than 25 years. Dr. B works in our Scottsdale, Arizona clinic.

Debunking the West Nile Virus Hysteria

West Nile Virus has shown up in Texas, and to hear it described somewhat breathlessly, you would think we were talking about Ebola, Hantavirus or the End of Days. It is the virus of the week and has caused a lot of commotion and more than a little fear.

Don’t worry.

West Nile Virus is a lesser known relative of Japanese Encephalitis, which sounds like a terrible disease, but really isn’t.

How do you get the West Nile disease? Only one way, get bit by a mosquito that has the virus. The West Nile virus mostly lives in birds. Some mosquitoes bite birds and pick up the virus that way. Who knew mosquitoes bite birds? Seems like a suicidal food choice. If one of these mosquitoes actually manages to catch and bite the infected bird, and survive the experience, he now can bite you. As you would expect there are not exactly swarms of infected mosquitoes.

Now if one such infected mosquito manages to find you, you now have West Nile Virus. But you can’t give it to your family and friends. They have to find their own infected mosquito if they want the virus. In West Nile infected humans, the virus level is low enough that a mosquito biting you won’t likely get infected. So you can‘t pass it on, even with a mosquito’s help.

But what if you do catch it? You have a very big chance of not even knowing it. 80% of people that get West Nile are asymptomatic. That is the kind of disease to get, beats all that suffering stuff.

20% of people actually get the short end of the virus, and feel like they have the flu (influenza). That can be pretty unpleasant: fevers, chills, sweats, headache and body aches, swollen glands and maybe a rash or some vomiting thrown in for good measure. You are going to spend a perfectly miserable 7 to 10 days, then you will be fine, and immune. The only thing that might make you feel better during that 7 to 10 days is knowing you don’t have the really bad kind.

The really bad kind is less that 1% of the infections. It infects your brain and that is never good. In the worst of the worst the encephalitis (brain infection) can cause coma or death. There has even been some Guillain-Barre (remember swine flu 1975 version) from West Nile Encephalitis. Once it gets to that stage you are in the ICU and we (as doctors) do everything we can, but there is no specific treatment. Still most people get over it.

Although there are a lot of West Nile Alarmist stories hitting the airwaves, the disease is pretty simple to avoid. Mosquitoes bite most actively around sundown. Stay away from the wood at that time. If you live in an area that has West Nile, consider some mosquito repellant (DEET) spray or clothing. It’s as easy as that.

Did you know it was the carbon dioxide in your breath that attracts the mosquitoes to you? Just thought you’d like to know.

Take Care

Dr. B

 

Image: FreeDigitalPhotos.net

 

CDC Announces the Official Start of the Flu Season

Did I miss something, or are we talking about flu in mid-February? Isn’t that like the kids asking you about Halloween instead of Valentine’s Day? My response, after a microsecond of disorientation, is “What, where did that come from?” That is how I feel about a spring influenza epidemic.

Influenza usually misbehaves in a reassuringly predictable fashion (there’s that kid analogy again). This flu season “beginning” is the latest in the last 30 years, according to the CDC.

A short primer: Influenza germs hang out in poor countries in the Southern Hemisphere where people and animals live together. That seems a surprising thing but, if your pig or goat is your most valuable possession, you don’t let him out of your sight. Most of the new influenza viruses cross over from animals into humans where they live together. Thus animal “flus”: Swine Flu, Bird Flu, etc.

So a new and improved (from the viruses’ view) influenza virus goes out to make its mark on the world. That is somewhat easier these days with our migratory populations of air, rail and ship travelers. There is a several day incubation period where you have the virus and are infected, but you don’t look bad or feel sick yet. That’s the problem.

So why is influenza a winter bug anyway? A lot of scientific study has gone into answering this simple question. There are aspects of the germ that make it winter friendly. The viral coat is soft, fragile and almost like mucus in warm temperature, and hard and durable in cold temperatures. So the virus lives longer in the winter.

We are also better hosts for the germ in the winter. The air is so dry our lips are chapped and cracked and so is the rest of our respiratory tree. These tiny cracks let the germs in easily. We are crowded together in schools, airplanes and churches, breathing each other’s air and, unfortunately, someone is always sick. Buildings are more tightly sealed to keep out the drafts and keep the warm, moist (possibly infected) air on the inside.

For influenza to get going, it has to land in a population of susceptible, unvaccinated people.

So here we are, thinking about spring, and the CDC is telling us influenza is on the rise.

Blame it on global warming, the ozone hole, or the illiteracy rate in America, but here it comes.

Expect a steep rise in cases in the next few weeks. I am already seeing some really sick people in my office. They have high fevers (103), body aches like they took a beating, a headache and sometime nausea. They looked like they wanted to die (I was careful to keep them away from sharp instruments).

So, while it seems a bit late to be talking about flu shots, flu season is finally arriving.

The realities are that flu vaccine is still thankfully available. Flu vaccine is still a really good idea if you want to save yourself some major misery. Remember it takes about nine days to develop good flu immunity after a flu shot. So, what are you waiting for?

Take Care,

Dr B

Healthy Holiday Travel Tips

Here are some tips to make sure you reach your destination this holiday season without contracting a nasty cold or the flu.

'British Airways 777 G-YMMA' photo (c) 2006, Doug - license: http://creativecommons.org/licenses/by-sa/2.0/
Get a flu vaccine as soon as possible. The current vaccine is widely available in almost all communities. Although this requires acting soon and planning ahead, it is the absolute most important factor.

Get adequate rest the night before travel. Having seven to eight hours of restorative sleep will give you a fighting chance of resisting whatever exposure you get when traveling. Travel days are usually long and hectic. If it can be avoided, you don’t want to start your day already run down.

Make sure you have a pocket-sized Kleenex, Purell, and saline nasal spray. Using hand sanitizer periodically after touching public surfaces once you settle into your seat and before eating is important. Avoid touching your own face, nose or mouth with contaminated hands. Usually illness such as the flu and other common respiratory illnesses are not airborne. They don’t fly over your left shoulder while you are looking the other way. The majority of transmission is self-inflicted. You have the germs on your hands and then eat, touch your nose or mouth.

Keep an arm’s length from other travelers and airport attendants when possible. Be aware that others may be sick and not be so mindful when they cough or sneeze. This is tough to avoid in close quarters, especially in your seat on an airplane. However an understanding and awareness could prevent you from being the unsuspecting target of their germs.

During your flight, stay well hydrated. The cabin air is usually very dry. For comfort, occasional use of saline nasal spray is good. Keeping the nasal mucosa moist and generally staying well hydrated will make you less vulnerable to the unavoidable germs you may encounter. Eat wisely and avoid alcohol during your flight.

Prolonged sitting in cramped positions puts you at risk for blood clots or phlebitis. Even a healthy person is at risk. The cramped position, lack of regular muscle movement in the lower extremities, high altitude and not drinking enough water can put you at risk. Deep Venous Thrombosis (DVT) is a very serious medical condition caused by blood clots in the legs. If untreated, it can lead to life threatening problems. Wear comfortable nonrestrictive clothing. Wiggle toes and feet. Stretch legs periodically if the space allows. Get up and move around the cabin briefly every 20 to 30 minutes. Changing position and physical activity can help restore sluggish circulation which puts you at risk.

If you have any chronic medical problems, consult your health care provider before your trip. Even some medications can increase your risks. Your physician may recommend a medication or aspirin prophylaxis for the trip.

Don’t let paranoia about germs or DVT distract you from the enjoyable goals of holiday travel. A few simple steps and planning should help you have a happy, healthy and successful trip.

– Dr. Bruce Kaler

Can The Flu Make You Go Bald?

Just when you thought you had heard everything about the flu, something new comes along.

'Moon Scape of Bald Head' photo (c) 2008, malehmann - license: http://creativecommons.org/licenses/by/2.0/
The Journal of Dermatology recently reported that swine flu has been associated with alopecia arietta. That means influenza can make you bald, or at least partly bald.

Alopecia Areata is a condition where a patch of hair falls out and you have a bald spot. It isn’t well understood, it’s idiopathic (meaning we doctors haven’t figured it out). The condition is believed to be caused by your body attacking your hair follicles. That makes it a relative to autoimmune disorders like Lupus or Rheumatoid Arthritis. Why exactly this happens remains unclear, but there are clear triggers for this.

What is a trigger? That is something that sometimes starts a medical problem, which the person had a tendency toward. This tendency is genetic, but we don’t know how to test for it. A lot of things in medicine are like this. You may know someone who is 80 and has smoked all their life, or an alcoholic who doesn’t get cirrhosis.

The trouble is we can’t test for this tendency. If we could, our patients would love us. We could do a test and tell you it’s OK for you to smoke, drink and eat junk food. The next patient we could tell to exercise and be vegetarian or they won’t see 40.

We just don’t yet know enough to sort this out.

A bit of good news is the swine flu is the main flu circulating this season, and the vaccine prevents it. Alopecia Areata is not the end of the world. The hair usually grows back after several months or a year.

But partially bald is not my planned look for Christmas.

Stay well (and get your flu shot).

Dr B.

What is Flu Vaccine Anyway?

We spend a lot of time each fall talking about influenza and flu vaccine. A great deal of hard work by very smart people goes into making this magic fluid each year.

'Flu Vaccination Grippe' photo (c) 2010, Daniel Paquet - license: http://creativecommons.org/licenses/by/2.0/

The first thing you need to make flu vaccine is a flu virus. Those come in many different flavors, some old standbys trying to make a comeback, occasionally some new virus. Because the earth is tilted, our summer is the Southern Hemisphere’s winter. They are having this year’s flu season 6 months before we do. The best place to look for new influenza viruses are poor rural areas in Southeast Asia. In these areas, humans and animals frequently live close together. I’m sure you have noticed all influenza viruses have animal names (swine flu, bird flu…) – that is because the virus jumped from an animal to a person.

The World Heath Organization (WHO) is in charge of collecting flu viruses. They culture a bunch of sick people (nasal swab) to find the new and dominant viruses that season. They get pure cultures of the three worst viruses.

Now the magic begins.

Each virus is combined with a harmless standard lab virus. The result is a new virus that looks like the bad influenza virus on the outside, and like the harmless lab virus on the inside. That is important because the human body generates antibodies to the outside of the virus (it can’t see the inside). Now we have a copy of the virus that can’t make people sick, and grows well in chicken eggs. All this happens at the WHO labs.

Next it’s off to the vaccine manufacturers.

This harmless copy virus is injected into fertilized chicken eggs that are 9 to 12 days old. Three days later there are almost countless copies of the virus in the egg white. The virus is then separated from the egg white. Now it’s time to kill the virus with chemicals as we don’t want anyone being infected by this new virus (even though it is harmless). Now the virus is broken up to get a solution of the surface proteins (those on the outside).

This solution, called antigen, is then diluted to the proper concentration for use.

Next, it’s sterilized and packaged in vials and syringes.

There are hundreds of quality assurance tests done at each step of the process.

So your flu vaccine contains just the proteins from the outside of the original bad virus. It doesn’t have the ability to infect you as there is no living virus in the vaccine.

When you get your flu shot, these proteins (antigens) in the vaccine stimulate your body to make antibodies against this interloper. These antibodies will attach to the original virus and destroy it. In about 9 days you have enough antibodies to fight off an assault by the original virus.

It takes six months from finding a new virus to mass-producing the vaccine. That original virus was found in our spring (the Southern Hemisphere’s fall) and is ready for use by our fall season – just in time for flu season.

Producing the new trivalent (3 viruses) vaccine each year is one of the things the human race does very well; it requires worldwide cooperation to pull it off.

So, when you get your flu shot this year (and do it soon to maximize your protection), appreciate the “magic” that half cc of vaccine represents.

Take care

Dr B