The most recent information collected by the US National Poison Data System which is the annual report of the American Association of Poison Control Centers, showed there were 0 deaths caused by any dietary supplements in the United States in 2008 (the latest year with complete information available).  Various data suggests that half of Americans take dietary supplements, which amounts to somewhere around 56 billion doses of supplements in a year.  Of those 56 billion doses, there were NO (zip, zero, zilch, nada) deaths from the best available data we have.

Compare that to deaths from pharmaceutical drugs, which are well regulated and much safer than supplements, and then tell me how dangerous supplements are again.

You can download the Annual Report of the American Association of Poison Control Centers for free here.

What are your thoughts?  Share them with us in the comments below.

Unfortunately as an alternative provider, the medical evidence used to ration care still almost exclusively excludes the kind of care I do, meaning many patients are unable to benefit from it.

The article is a little long, but worth reading.  Find it here.

What are your thoughts?  Is rationing an unfortunate necessity?  Share them with us in the comments section below.

When I think of a personal trainer, the stereotype of a big chain gym trainer comes to mind, the “buff” guy or gal who runs people semi-mindlessly through a circuit of gym machines (my apologies to all the quality personal trainers out there, I recognize this is a bad stereotype).   Ross doesn’t do anything like this.  I half expected to be told to do this exercise or machine and then do that one, but our session was completely different.  Ross started by getting a history of my physical injuries (thankfully few and far between) and then asking about my goals (continued pain free movement and the ability to continue to do all the activities of daily living like picking my son up and carrying groceries, etc.).  He then put me through a functional movement screen, which is a series of exercises designed to demonstrate your strengths and weaknesses.  We found, not unsurprisingly that I had poor hip mobilityand instability in my lumbar spine both secondary to sitting at a desk much of the day.  Ross then put me through a basic serious of exercises slowing them down, cutting the weight and focusing on good form.  It was honestly like yoga using weights.  At the end of the session the difference in my posture was easy to see in the mirror.

My goal is to connect with other practitioners who are not only good at what they do, but have a passion for it.  It can’t just be a job, it must be a calling.  After spending some time working and then chatting with Ross it’s clear to me how much he loves his work.  I felt, not only that I had gotten a workout (with its own benefits), but that I had actually done something even greater to improve my health by balancing out my posture.

If this sounds interesting to you, or you are looking for a personal trainer that focuses on bringing balance and symmetry back to your movement patterns and body, I highly recommend Ross.  He can be reached at (206) 790-5171 or ross@realhealthseattle.com.  He tells me his website www.realhealthseattle.com is being reworked and will be up in running in a few weeks.

And just to be clear, I have no financial relation with Ross whatsoever, and I get no compensation of any kind by making this post.

What are your thoughts?  Have you used a personal trainer?  We’d love to hear about it, share your thoughts in the comment section below.

Let me give you an example.  A woman had severe seasonal allergies, she dreaded pollen season with a passion.  She was on the maximum doses of all the allergy medications and was still barely keeping her allergies under control.  Blood allergy testing showed that she was very reactive to wheat, dairy, and eggs (the big 3).  She cried a little bit at hearing this because it meant that virtually everything she ate on a regular basis was out.  But she took to the challenge with relish, and decided that this was going to be her chance to get back into the kitchen and experiment, finding tasty foods that she could eat and enjoy.  Within a few weeks her allergies were gone completely.  She stopped all of her allergy medication and has had no sign of her allergies, unless she eats some dairy, wheat, or eggs.  She is thrilled with her results and couldn’t be happier she took the plunge and did an elimination diet.  And for those who worry about giving up groups of foods forever, I expect over time as her gut heals and her immune system normalizes she will be able to reintroduce most of those foods back into her diet.

Before undertaking an ECD it’s important to determine your motivation.  What is going to give you the drive to persist through the early cravings?  What is going to allow you to say no when you get in situations where it would be so much easier to simply say yes?  Unless you plan to be a hermit for the 3-4 week duration of the elimination part of the diet, you need to have motivation.  One strong source of motivation is others.  Most of us don’t tell anyone about any diet or lifestyle changes we’re trying to make, that way if we fail, no one knows.  Turn that around, and tell all your friends, tell your co-workers.  Enlist their help and let them hold you accountable.  That way when you are tempted to reach for that food you know you others are going to know.

For me, I have three sources of motivation.  The first is simply curiosity.  As mentioned in my previous post when we saw the changes a change in diet caused in our pets, I became curious.  What changes would I see in myself if I did the same?  So this is an experiment to see what happens.  The second source of motivation is my desire to have experienced the therapies I ask my patients to go through.  It is a belief of mine to, whenever possible, try the therapies out on myself that I recommend to my patients.  That way I know what the therapies feel like, and it helps me understand what my patients are going through.  The ECD is one that I have held out on, because without any major health problems I simply did not want to give up the foods that I enjoy.  The third source of motivation is others, when my wife and I first came up with the idea, the first thing I did was quickly post the idea to my blog and to my mailing list.  That way, many people know about this, and are going to hold me accountable for completing it.

If possible, get your friends or family to join you on the ECD (often easier said than done).  It’s especially important to have the help of people you are living with.  If you can all go on the diet together it creates a shared camaraderie and helps to keep the foods that have been removed out of the house.

Stay tuned as this series on the ECD will continue.

Do you have any thoughts on the ECD?  Have you tried one?  We’d love to hear your comments, please post them in the comments section below.

The quickest way to be labeled a quack is to openly admit that you practice homeopathy.

So what is homeopathy?

Homeopathy is a system of medicine developed in the 18^th century by a medical doctor named Samuel Hahnemann who was so disgusted by the practice of medicine in his day that he set out to find a better way to practice.  What he created was a system of medicine founded on completely different principles from our modern conventional one.  It is so different in fact that it seems to make no sense.

1. That a substance that causes symptoms when given to a healthy person can cure those same symptoms in a sick person.  This runs counter to our conventional system of medicine which uses primarily anti- medicines (antibiotics, antihistamines, anti-inflammatories, etc.) and doesn’t seem to make much sense.
   1. Homeopathy doesn’t determine how medicines work by analyzing their molecular structures or testing them on animals but by giving them to healthy people.  These healthy people are monitored for what symptoms they develop.  For instance, taking a substance may produce a dry, irritating cough.
   2. This substance is then given medicinally to people with a dry, irritating cough in order to help the person resolve the cough.
2. That a substance can be diluted to a level where statistically no molecules of that substance remain and yet still have an effect.  While the first principle is strange this is the one that gets everyone in an uproar. This runs counter to the conventional system of medicine which is organized around biochemistry.  If there are no molecules of the substance left, how can it have an effect?

Let me say this right now.  We have no idea how homeopathy works.  There are many theories; Hahnemann proposed some back in the 18^th century, as have many people since then, but no one knows how it works.  But there is a critically important difference between saying we don’t know how it works, and that it CAN’T work.

No true scientist will say that something CANNOT work, they might say they believe that it won’t work, or that there is no evidence that it does work.  But the statement it cannot work is a belief not science.  After all everyone knew the Earth was flat until we discovered it wasn’t, and the Sun went around the Earth, until we discovered it didn’t.  The Church members refused to look through Galileo’s telescope because they knew without looking that what he said could not possibly be true.

Statements that there are no scientific studies showing homeopathy works are false.  Studies on homeopathy are mixed.  Some show that it is no better than placebo, others that it is.  Could it be placebo (work only through the power of the mind)?  Possibly.  But we also thought arthroscopic knee surgery really worked until we discovered the effects were merely placebo.  Figures I have seen quoted suggest 30% or more of the medicines we use everyday are placebo.  Many of the positive effects we believe come from our medicines (conventional and alternative) are the result of the placebo effect.  But homeopathy has also been used effectively on pets (dogs and cats) and livestock (horses, pigs and cows) which makes it much harder to argue the only effect happening is from placebo.  Homeopathy has also been used on babies and comatose patients (a real stretch to say that there is any placebo effect on someone in a coma).

Why do I use homeopathy? Because in my clinical practice I have seen it work.  I have seen it work on small things and I have seen it work “miracles.”  Does it always work?  No, nothing always works.  If it is just a placebo, I don’t care.  It is cheap, it has few side effects (things that cannot be said about most conventional medicines), and my primary concern is to see people get better, and I am less concerned with how they get better.  I use homeopathy as one of the tools in my medical practice to help people live a high quality life.

For an entertaining, easily readable short work published in 1896 on why an MD became a homeopath, download this free book here.  J Compton Burnett was a medical doctor who, frustrated with his inability to help people get better turned to homeopathy.  Despite tremendous skepticism he was so impressed with his experiments in homeopathy that he became a homeopath.  Challenged by one of his conventional peers to state why he used homeopathy, he wrote this little book of his 50 reasons.

What are your thoughts?  We’d love to hear them?  Have you ever used homeopathy and did it help you?  Share your comments below.

Part II here

In part I of this series we answered the basic question, what is evidence based medicine (EBM) with the definition:  EBM is the equal use of clinical experience and external evidence to make the best decisions about the care of patients.

In part II we saw how this definition is often discarded for the much more stringent and less useful definition of EBM as the selection of therapies according to the evidence presented in the scientific literature.  This evidence is ranked with double blind, placebo controlled studies at the top (considered most authoritative) and clinical experience at the bottom (considered least reliable).

In part III, my intention is to outline how I use EBM in my practice.  Alternative or natural practitioners are often dismissed by conventional practitioners with the refrain “not enough evidence” or “hasn’t been proven to work”.  This is true only under the strict definition of EBM we talked about in part II but as I will show I base my practice on a great deal of evidence, much of which is not given significant value by the conventional community.

In my practice of medicine, I break evidence down into four quadrants.

Quadrant I – Tradition

The use of food and plants as medicines dates back to the beginnings of humanity and is found in every culture around the globe.  The most widely known traditional medical systems are Chinese medicine and Indian (Ayurvedic) medicine which have experience spanning several thousand years, and many generations of healers.

There is a tendency in modern culture to view our predecessors as ignorant or at the very least to think, “they were doing the best they could, but we’re clearly so much smarter and better than they are, after all we have iPods and electricity…” and to discount their knowledge and wisdom.  I think this is an arrogant and prideful view.  Our ancestors faced many of the same health problems we face today and generations of experience helped them to accumulate a wealth of wisdom about what heals and what doesn’t.

This is not to say that tradition has all of the answers, it doesn’t.  Superstition pervades this quadrant, some of the therapies our ancestors used were ineffective and some were downright harmful, and the conditions of our modern lives are uniquely different from those of our ancestors.  But to throw out this quadrant of evidence because of these flaws is to “throw the baby out with the bathwater.”  We have much to learn from our ancestors, and in my opinion, evidence based medicine starts here.  I look at how my Naturopathic predecessors treated disease and restored health, and how traditional cultures around the world used food, plants and other medicines.  To this base I add…

Quadrant II – Scientific literature

Because I am a Naturopathic doctor (ND) and not a medical doctor (MD) I have been called anti-science.  Let me be clear, I am NOT anti-science.  I value and use science, but I also do not revere science.  For me it is one of four quadrants of evidence, not the only quadrant.

Science is incredibly valuable.  At its best it helps us to uncover mechanisms of action so we can more deeply understand how diseases and medicines work, and how to better use our medicines.  It also helps us strip superstition and bias out of tradition and our own personal experiences.  But science is also a human endeavor and not something passed on down from ‘on high’.  Recent exposés have shown the bad side of science, manipulated for monetary gain: some scientific studies are ghost written by marketing people looking to influence the prescribing habits of doctors, some pharmaceutical companies hold back scientific data that would make their drug look worse, and that studies are manipulated from the very beginning to give the results that are being looked for.

Scientific studies are not gospel, and in my opinion, need to be taken in the context of other quadrants of information.  So to them we add…

Quadrant III – Personal clinical experience

Nothing can replace a doctor’s experience with their patients and their medicine, which is why we all value a doctor with years of experience.  A doctor’s experience working with their therapies, seeing what works and what doesn’t on real people in front of them, gives personal knowledge of that therapy that cannot be learned from tradition or the scientific literature.

This is not to say we should rely only on clinical experience because we are all subject to our biases and the biases of our patients and the population that we serve.  But by placing it in the context of the other quadrants we gain irreplaceable knowledge.  The last quadrant is…

Quadrant IV – Non-rational or intuitive

This is the hardest category to explain, and as such is often just ignored and swept under the rug.  Medicine is not just a science, it is also an art.  Hunches, gut feelings and intuitive leaps of thought play a vital part in the practice of medicine, even for the staunchest scientific practitioners.  Sometimes we choose therapies because it simply feels right.

Each of the four quadrants provides valuable evidence that I feel is, in and of itself, insufficient for the practice of EBM.   Conventional medicine, I believe, makes the mistake of discarding quadrant I (tradition) and IV (intuition), minimizing quadrant III (clinical experience), and attempting to rely almost exclusively on quadrant II (scientific literature).  Alternative medicine, I believe, also makes the same mistakes by rejecting quadrant II (scientific literature)  attempting to rely almost exclusively on quadrant I (tradition) and III (clinical experience), while some alternative practitioners think quadrant IV (intuition) by itself is enough.

I value each quadrant equally, and do not rely on any one to provide all the evidence for my treatments.  The strongest evidence is where each quadrant converges with the others; where a traditional use is verified by modern scientific studies, the clinical experience of the doctor and their peers, and by the practitioners and patients non-logical intuition.   This I believe is truly comprehensive, holistic EBM and best serves patients.

What are your thoughts?  We’d love to hear them, please post your comments below.

Part III of this series

In part I of this series, I explained what I believe evidence based medicine (EBM) should be:  the equal use of clinical experience and external evidence to make the best decisions about the care of patients.  In this interpretation of EBM both clinical experience and external evidence are important and necessary.

Clinical Experience <—-> External Evidence

Unfortunately this interpretation is rarely used in current discussions of EBM.  Instead we find this version of EBM widely promoted.

1.  Randomized, controlled studies

2.  Other studies

3.  Clinical experience & “consensus” opinion

Under this interpretation, the value of evidence is now ranked.   Double blind, placebo controlled studies are given the highest value, followed by a variety of other studies, and lastly clinical experience and consensus views from committees, associations, and experts.  Instead of external evidence and clinical experience being given equal weight we now find that clinical experience is considered the least valid (and valued) form of evidence.

This form of EBM is often used to disparage and discredit alternative or non-mainstream therapies with the refrain, “there’s no / not enough evidence” because the only evidence considered worthwhile is that produced from studies, and especially from double blind, placebo controlled studies.  The reports of hundreds or thousands of doctors and hundreds of thousands or millions of patients are brushed aside with the comment “anecdotal” as if that means they have no value.

To run a well conducted scientific studies, especially double blind placebo controlled studies, requires  scientists to be hired, the study designed, subjects recruited, screened, and selected, the trial run for weeks, months, or years (in some cases), the data collected, analyzed and then published.  All of this isn’t free and in fact costs a tremendous amount of money.

The government does sponsor some studies, but the current budget allocated for studying alternative therapies is pathetically small.  The majority of studies are funded by private companies, and in a capitalistic society the goal of business is to make money.  Studies funded by private companies are not done to prove whether a therapy is effective or not, but ultimately to prove that their therapy (being studied) is effective so that the results can be used to promote that therapy, and make money.

For example, a pharmaceutical company comes up with a drug they believe might have potential, they patent it which gives them exclusive rights to sell it for a period of time.  This ensures that if the drug is shown to be useful they will be the only ones who can sell it and therefore they will be able to make a lot of money with it.  The company will then fund scientific trials to prove that it is effective and bring it to market.

In contrast, something like vitamin C is cheap and widely available.  It is a natural substance and so cannot be patented.  If a company paid for a study on vitamin C and found it beneficial, anyone selling vitamin C could use the study to promote their brand of vitamin C.  The company that spent the money to have the study done would not have any advantage because they cannot patent and hold exclusive rights to vitamin C.  In fact the sponsoring company would be at a disadvantage because they spent the money to have the study done, while competitors could use the results of the study for free.

Pharmaceutical companies run the majority of trials on medical therapies, and because they cannot own natural therapies most natural therapies are not studied.  Further, as many natural substances may be replacements or alternatives for drugs, pharmaceutical companies have a further disincentive to conduct trials on natural substances.  The only studies they would have interest in running are those that prove that natural substances don’t work or are inferior to their products.

Therefore as alternative practitioners we find that the majority of our therapies are not studied in scientific trials, because there is no profit in doing so.  Most supplement companies, alternative medical societies, associations, and schools are small and don’t have the millions of dollars needed to run the studies to “prove” that the therapies work.  Evidence from practitioners and patients is discounted as anecdotal and therefore “worthless”.

Under this version of EBM, the conventional community claims there is no evidence to support the use of alternative therapies.  However, if we turn this same standard upon the conventional community, we find they have little evidence to support many of the practices and therapies they use.  By some estimates, up to 80% of conventional practice do not have sufficient studies behind them to justify their use under this version of EBM.  Most MDs rely on evidence presented in scientific journals, what they are told by pharmaceutical representatives about medications, their own clinical experience and the consensus opinion of their colleagues and medical associations to provide evidence for the use of their practices and therapies.  The majority of this evidence is considered lowest tier evidence under this version of EBM.

It is my belief that this version of EBM sets unrealistic and non-usefully high standards for what can qualify as evidence to justify therapies and practice, and by doing so denies patients effective care.  In part III of this series I will lay out the form of EBM that I use in my practice and how I feel it best serves my patients.

What are your thoughts and opinions on EBM?  We’d love to hear them.  Feel free to share them below.

The first step is avoiding obvious sources of gluten like breads, pastas, pastries and the many other things made with flour.

More insidiously however, gluten is added to many foods.  People with CD need to become good label readers.  The majority of processed foods (that come in a box, bag, or can) have added gluten to them.  For a list of names you need to look for on labels, look here.

Contamination can also be an issue.  Cutting boards, utensils (knives and forks) and other kitchen implements used to prepare gluten dishes can pass on enough gluten by contamination to trigger auto-immune reactions in people with CD.  Therefore it is best to have a set of kitchen equipment that is only used to prepare gluten-free dishes to avoid possible contamination.

Drugs and supplements may also contain gluten in the form of binders and stabilizers used to make the pill or put in the capsule to fill up space.  A patient with CD may be doing a great job avoiding gluten in the food they eat and still getting gluten from the prescription drugs or supplements they are taking.

I was delighted to find this website, put together by a pharmacist listing medications that contain gluten.  This gives people with CD the opportunity to see if they are getting gluten in their medications and if they are find alternatives.

If you or someone you know has CD I highly recommend checking out www.glutenfreedrugs.com.

Have you run into trouble because of gluten in your drugs or supplements?  Do you have any thoughts?  We’d love to hear them, post them below!

Part III here

Evidence based medicine (EBM) has emerged as one of the key concepts being debated in leading medical journals, doctors offices and conventions, insurance boardrooms, and government agencies  as a major piece of  the effort to reduce costs and improve outcomes in medicine.  In this series I’ll be explaining what evidence based medicine should be (part I), is (part II), and how I use it in my practice (part III).

The definition of evidence based medicine I believe makes the most sense comes from this paper.  BMJ 1996;312:71-72 (13 January) Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS (1996). “Evidence based medicine: what it is and what it isn’t”. Excerpts from the paper will be in italics.

“Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”

The intention behind evidence based medicine is a good one.  As doctors we want to carefully and consciously use the best evidence to select therapies that are helpful to patients, and avoid those which are harmful or useless.  As the article says:

“[The purpose of evidence based medicine is to] invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious [effective], and safer.”

Whatever gives us the best results is what we want to use for the good of our patients.  But, how do we decide what is the best evidence?

“The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”

We combine our clinical experience as doctors (personal, subjective evidence) with the best evidence from external sources (impersonal, objective experience).   In contrast to what we will see in part II of this series, we see that evidence based medicine combines the clinical experience of the doctor with external sources, such as the scientific literature.

The article continues: “Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannised by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients.”

In this view of evidence based medicine, which I subscribe to, both clinical experience and the scientific literature are equally important.  One without the other is insufficient and leads to poor practice and outcomes.  Clinical experience without external evidence is narrowly focused and becomes quickly out of date, and the external evidence without clinical experience attempts to fit a “one size fits all” solution to individuals, which typically works very poorly.

In part II, we’ll move away from what EBM should be, to what it most often is.

What are your thoughts and opinions on EBM?  We’d love to hear them.  Feel free to share them below.

Bottom line:  “Remove the term H1N1 from the equation.” If your child had regular flu, would you take him to the hospital? If the answer is no, then don’t take him/her to the hospital now.

—–

People were scared [mainly due to the media’s hype and constant coverage of H1N1, along with declarations by governments and health organizations of pandemics and national emergencies].   Health care professionals were blaming the media — accusing them of being alarmist [most health care professionals working with patients, not those working in government or for the media, are not overly concerned about H1N1].  The doctor who met me [in a pediatric (kids) emergency room] started by saying he was giving the media a C+ in its overall coverage of H1N1, and blamed his busy ER, in part, on the media for stoking fears.

There is no question that pediatric emergency rooms are much busier than this time last year — about two to three times busier at the ER I visited, [but] many of the patients sitting in the waiting room were there with flu-like symptoms, worried about H1N1.  [In the media we hear that emergency rooms are slammed with patients and barely able to keep up, giving us the impression that most of these people are deathly ill, when in fact the vast majority are there with colds or flu-like symptoms that do not need medical attention.  Most are briefly examined and told to go home.]

[Dr. Gupta’s recommendations for parents:]

Point 1. As things stand now, the vast majority of children who develop flu-like symptoms this fall will have a few miserable days, and nothing more. And those days are best spent at home — not in the ER or a doctor’s office.

Point 2. If you are worried, you should call your pediatrician’s [or Naturopathic doctor’s] office first. Don’t take your child in without calling. Two reasons: Your child may not have H1N1, but could become exposed by being around sick children. And, after several hours of waiting, you are still likely to be told the basics — plenty of fluids, rest and dose-appropriate acetaminophen for a fever [I strongly disagree with the recommendation to bring down a mild-moderate fever with aspirin or acetaminophen as research has shown that doing so will INCREASE the length and severity of an illness.   A fever is part of the body's natural defenses against an illness.  In children if the temperature is less than 104 F and the child is tolerating it well there is no need to bring the fever down, simply make sure the child does not become dehydrated by supplying plenty of fluids.  If the fever needs to be brought down a short bath in tepid (luke warm) water is the best way to do so.]  After all, it is still the flu we are talking about.

Point 3. One doctor told me a way to think about things that was helpful. He said “remove the term H1N1 from the equation.” If your child had regular flu, would you take him to the hospital? If the answer is no, then don’t take him/her to the hospital now.

Point 4. Yes, hearing between 30,000 and 90,000 could die from H1N1 is scary, but keep in mind — around 40,000 people die from the regular or seasonal flu every year. The numbers may not be that much different, yet there is not panic about the regular flu. As things look now, H1N1 is causing only mild to moderate illness, not the widespread deaths people are worried about.

Point 5. There are some children who should be seen by their doctor. Call your doctor if:

• A baby younger than 12 weeks has a fever greater than 100.4 degrees Fahrenheit

• A child, older than 12 weeks has a fever for three days

• A child’s fever returns after a 12-24 hour time period

• A child is not passing urine or making tears for more than six hours

• A child does not smile or show interest in playing for several hours

Dial 911 if:

• A child cannot speak while trying to breathe

• Has a blue or dark purple color to the nail beds, lips or gums

• Is not responding to you because he is too tired or weak

One point that was reinforced to me over and over again by the pediatricians is the best place for a sick child is at home. And, with regard to school — after 24 fever-free hours without the aid of medications, he or she can go back.

This is the advice that my wife and I will be following this fall for our own children. Hope it is helpful to you, and the media can score an “A,” at least this time around.

[Full unedited, article here]

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Very reasonable advice.  If you or your child comes down with a flu-like illness, don’t panic.  As long as the sick person is handling the illness well, there is no need for further treatment or concern.  The most important therapies are to stay home, rest, and get plenty of fluids.  If things take a turn for the worse (high fevers, extreme lethargy or trouble responding, or any of the warning signs listed above) get a medical professional involved.  But remember, for the vast majority of people, H1N1 is a mild to moderate illness, not a life-threatening one.

What do you think?  Have you had swine flu this year?  How did you treat it?  We’d love to hear your thoughts.  Please post below.