A: You are not alone in your reaction to fragrances. A study utilizing phone surveys, Prevalence of Fragrance Sentivity in the American Population, published in the Journal of Environmental Health (March 2009), concluded "Results from both surveys indicate that a considerable segment of the American population has adverse reactions to fragranced products, with 30.5% reporting that scented products on others are irritating, 19% experiencing headaches, breathing difficulties,and other problems from air fresheners or deodorizers, and 10.9% being irritated by the scent of laundry products, fabric softeners, or dryer sheets that are vented outside." (http://depts.washington.edu/exposure/Caress%20and%20Steinemann%202009.pdf) I am not aware of any local or state laws or regulations that address fragrance sensitivity in public places. The federal American with Disabilities Act (ADA) might apply in severe cases. The Seattle Office for Civil Rights had a report in it's June 2011 newsletter with recommendations for fragrance-free policies for worksites, which would also reduce exposure for sensitive individuals in the public (http://www.seattle.gov/civilrights/newsletter/jun11.htm) OSHA has a website with references regarding multiple chemical sensitivities, but does not provide specific policies or guidelines. (http://www.osha.gov/SLTC/multiplechemicalsensitivities/index.html) I am curious about the response of businesses you have told about your reaction to the fragrances they use in their facilities. It seems that it would be in their interest to accomodate the large proportion of the public that reacts to fragrances.

A: You bring up a good question about the role of office and laboratory testing for influenza. The office tests for influenza A and influenza B are quick, but not as sensitive or specific as the slower and much more expensive PCR tests done in the laboratory. The rapid tests are can show false positives when influenza activity is low in the community, and false negatives when there is a lot of flu going around. The decision to treat should not be based on the result of the lab test, whether in the office or the lab, but on the clinical picture (symptoms and exam), the person's risk of complications from flu, and on whether or not influenza is known to be circulating in the community. The CDC has a page, Guidance for Clinicians on the Use of Rapid Influenza Diagnostic Tests for the 2010-2011 Influenza Season, that describes this in more detail. Testing is most useful to track influenza activity in the community, to know which strains are circulating and how well they match the strains in the seasonal vaccine. The CDC, Washington State Department of Health, and the Whatcom County Health Department all publish weekly influenza surveillance reports online during flu season. These are useful for doctors in figuring out whether someone presenting with a flu-like illness is likely to actually have the flu.

A: The risk is negligible, so small that many health authorities say that there is no risk. This is because even high concentrations of radionuclides released in the air in Japan would be so diluted or settled out by the time it travels to the US that it would either not raise radiation levels above normal background, or only slightly so, and its relative effect on cancer rates would be miniscule if even detectable. Although fluctuating and sometimes very high levels of radiation have been detected at the plant in Japan, have been elevated in the immediate vicinity, and have led to water, milk and produce warnings as far away as Tokyo, the levels of radiation there are many thousands of times higher than the small amount that has been detected in North America after the material has been carried 5000 miles. To put the exposure into perspective, British Columbia has reported readings of 0.0005 microsieverts per day attributed to radiation from Japan. The average background exposure in Canada is 1800 microsieverts per year, or about 5 microsieverts per day, about 10,000 times more than the radiation reaching us from Japan. Natural background radiation comes from normal radionuclides in our bodies, in plants, soil and rocks, from cosmic rays (increased at high altitudes and with flight), and other sources. Artificial background ionizing radiation occurs from medical imaging or treatments, consumer products (as in fire detectors), nuclear weapons, and the nuclear power fuel cycle. Sieverts (and REM) are measures of biologically equivalent doses of radiation exposure. They take into account both the amount and the type of radiation (alpha, beta, or gamma) and its ability to penetrate tissue. This allows for a comparison of external source radiation (like chest x-rays) with inhaled or swallowed radioactive material. Many people have purchased or tried to obtain potassium iodide, which is used for preventing radioiodide uptake by the thyroid gland when there is a risk of exposure to high levels of radioactive iodine. This is useful in areas within several miles of the damaged nuclear power plant, but there is no benefit to using it for miniscule exposures. The risk of side effects from potassium iodide (including rare, but potentially fatal allergic reactions) are much higher than the risk from potential or miniscule amounts of radioiodide from Japan. Potassium iodide protects only from radioactive iodine, and not other radionuclides. Radioactive iodine has a short half-life of 8 days, meaning its radioactivity decrease by 50% every 8 days. In addition to dilution, time reduces the concentration of radioactive iodine. EPA , state health departments, and provincial health departments in Canada, are monitoring for radiation and for specific radionuclides. They are posting the readings online. We will not reach levels where inhalation poses a risk. If material gets deposited in soil or water at levels that put people at risk of cancer (the primary long term health effect), then measures will be taken, as they have in Japan, to prevent exposure to contaminated food, milk, and drinking water. Keep in mind that even with Chernobyl, where the radioactive material spread around the world, and despite the high levels of contamination locally and within several hundreds of miles, the levels detected in North America were never high enough to pose a detectable risk to health.

A: Your doctor is correct about the lump being very unlikely to be cancerous. Lipomas are benign (non-cancerous) growths of fat tissue. You can think of them in relation to fat as skin tags are to skin, an overgrowth of what looks like normal tissue under the microscope. About 1% of the population has lipomas. Most of them occur just under the skin, are rubbery, and are not attached to the skin. Liposarcomas are cancerous growths of fat tissue, and are very rare compared to lipomas. They tend to occur deep inside muscles or under the lining of the abdominal cavity. There are about 1000 cases per year in this country (about 3 per 1 million people). Given that the lump on your back is just under the skin, on your trunk, and feels like a lipoma to your doctor, means it is even more likely to be benign. It makes sense to have it removed if it causes discomfort, but both lipomas and liposarcomas are usually painless, unless they are pressing on nerves or other structures. When lipomas are removed, doctors usually send them to a pathology lab for examination to confirm they are not cancerous, and they almost always test negative for cancer.

A: Congratulations on the birth of your great-granddaughter! One of the gifts we can all give to infants and toddlers is making sure we are immunized against infections that can cause them severe illness. You and other adults and teens around the baby should all have the Tdap shot. This is the combination tetanus-diphtheria-pertussis vaccine that provides immunity to pertussis, the bacteria that causes "whooping cough". Although most children get the DTaP series as infants, and a booster around age 4, the protection decreases over time. It turns out that teens and adults catch pertussis, even if immunized when young, and pass it on to babies. Tdap vaccine is licensed for teens and adults up to age 64, but is safe to use in older people. The CDC just published its recommendation for people over 64 to get the vaccine if they are close contacts to infants and said that other people over 64 may get the vaccine, too. The Whatcom County Health Department doesn't provide the vaccine for adults. Check with your doctor or pharmacy, or give us a call (676-4593) to find out where they are available. If you want the details on the vaccine, here's a link to the CDC Advisory Committee on Immunization Practices report: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6001a4.htm?s_cid=mm6001a4_w

A: First of all, I recommend that the Safety Committee coordinate with Whatcom Unified Emergency Management in developing specific emergency preparedness measures. Potassium iodide (KI) is an agent for blocking the uptake of radioactive iodine by the thyroid gland, and does not protect against other radioactive elements. Radioactive iodine is associated with leaks from nuclear reactors and is not likely to be associated with a "dirty bomb". The decision to stockpile it should be based on a threat evaluation and the costs of obtaining and maintaining a supply. Given the absence of a nearby nuclear energy generator, the health department has not recommended local stockpiling. That being said, potassium iodide is available without a prescription. Although local pharmacies may not have it in stock, it can be ordered for personal and organizational emergency preparedness kits, and it is part of the Strategic National Stockpile, managed by the federal government for emergency response. It is important to follow dosing guidelines as it can be harmful to some individuals. The risk may be significant for certain medical conditions or if given at higher than recommended doses or for more than a couple of days. See http://www.bt.cdc.gov/radiation/ki.asp and http://www.fda.gov/Drugs/EmergencyPreparedness/BioterrorismandDrugPreparedness/ucm072265.htm for more detailed information on precautions and its use.

A: I'm not sure why you are getting a second dose of influenza vaccine. Only children age 6 months to 8 years of age need two doses, at least 28 days apart, if they hadn't received influenza vaccine previously. It's a bit more complicated because of the pandemic H1N1 vaccine last year (see http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5908a1.htm?s_cid=rr5908a1_w#fig3 for a detailed table explaining whether one or two doses is needed for a child). The reason two doses are recommended for previously unvaccinated children is because the first dose primes their response and the second is a booster. Four weeks is plenty of time for the immune system to respond to the first dose, and waiting longer risks the possibility of getting exposed to influenza before getting the full benefit of the booster vaccine dose. For older children and adults it takes about two weeks after vaccination to obtain a full immune response. If you want to see the full recommendations of the Advisory Committee on Immunization Practices for the 2010-11 season, go to http://www.cdc.gov/mmwr/pdf/rr/rr5908.pdf

A: I agree that the health care system has not prepared for post-peak oil, but our health care system, even with the recent health care reform, is not sustainable in many aspects, most of which are more acute. Public health, however, has been discussing the health impacts of climate change and of the decreased access to and increased costs of critical resources, like fresh water, food, and fuel. Although climate change and the health impacts of how we modify our environment have been the primary focus, post-peak oil is on the radar. We have been engaging in conversations about the impact of poverty and discrimination on differences in health status and access to critical resources, both within the US and globally, and have incorporated these conversations into our planning and response to communicable disease control, chronic disease prevention, and disasters. Since we work closely with health care providers, social services, business, and educational institutions on these challenges, this also informs our work with community partners. There is more to do, and we need to build a shared appreciation of our dependence on limited natural resources and the interdependence of economics, human and natural ecology, and health. Thanks for sharing the article. You might want to check out www.cdc.gov/nceh/climatechange and a Robert Wood Johnson Foundation report, Reaching for Healthier Life: Facts on Socioeconomic Status and Health in the U.S. - http://www.macses.ucsf.edu/downloads/Reaching_for_a_Healthier_Life.pdf

A: Your son probably has immunity to the 2009 H1N1 virus since he had an illness that was consistent with influenza and had a positive rapid influenza test, even though it wasn't confirmed as H1N1. We know from the CDC that over 95% of the influenza A virus circulating in the US since late spring last year was 2009 H1N1. However, the vaccine is recommended for those who did not have confirmation of H1N1, since it is possible, but not likely, to have a false positive rapid influenza test. There have been a few reports of second infections with 2009 H1N1 influenza. This can be because the person didn't develop a strong immune response to the first infection, or because influenza viruses change genetically over time and the immune response from the first infection doesn't fully protect from the slightly new virus. This shifting of virus genes over time is the reason we have annual influenza vaccines. Because the 2009 influenza A H1N1 continues to be the predominant influenza virus, it will be included in the seasonal influenza vaccine for this fall, along with an influenza A H3N2 and an influenza B component. Predicting the severity of the influenza season is harder than predicting the weather. At this time, we don't know if the new season will be mild, moderate, or severe. There is some increased influenza activity in the northeast, but still below the levels we saw last spring or this past fall.

A: Although some claim that influenza vaccines cause Alzheimer's Disease, I am not aware of reputable studies that show a risk of dementia, including Alzheimer's, from influenza vaccination. There is evidence of increased risk of hospitalization or death for diabetics from influenza infection. The Washington State Department of Health has noted that diabetics made up 17% of 985 hospitalizations or deaths from influenza in this state between 9/19/09 and 11/21/09 where risk factors were reported. A little under 8% of the US population is estimated to have diabetes, both diagnosed and undiagnosed . This is why influenza vaccination is recommended for everyone with diabetes. You should be getting a seasonal influenza vaccine every year and an H1N1 vaccine now if you haven't already. Most of the seasonal influenza vaccine was given early this fall, but H1N1 vaccine is still widely available. Although the second wave of pandemic H1N1 influenza this fall is over, a third wave might occur this winter. Even if we don't see a third wave, if you are not immune to the H1N1 influenza virus, you will eventually get exposed to it and it is safer to acquire immunity from vaccination than risk the complications of an infection and disease.