The US has declared a national health emergency because of the threat of a
"pandemic" of a virulent strain of influenza A, called "swine flu" because the
virus can also infect pigs.

It is essential that all people observe simple infection control procedures:

1. Hand washing is the single most important means of limiting the spread of
viruses and other infections. When you walk by a hand washing sink away from
your home, take a minute to do a careful hand wash. You should gently wash with
soap and water for as much time as it takes to sing "Happy Birthday".

2. If you are ill with flu like symptoms (fever, chills, muscle aches, cough,
runny nose) don't travel or go to public places. Seek care from your physician
promptly for testing and definitive care.

I am pleased to offer a cash discount plan that may benefit uninsured
patients, or patients who wish to reduce their fees and file their own
insurance claims.

I now offer a 25% discount on all fees, provided payment is made:

1. in cash (actual money)

2. in full (no balance on the account)

3. at time of service

Let us know if you would like to take advantage of this discount.

I will be out of the office beginning at 5:00 PM, Wednesday December
19 and will return at 8:00 AM on Wednesday, December 26. Messages will
be received and responded to as usual. I will also be out of the
office on Tuesday, January 1, 2008.

DrG

I will be in the office all day today, however icy road conditions throughout
the region may
make travel hazardous, therefore no cancelation fees will be charged to patients
who call to
reschudule their appointment. No show fees will be charged as usual for those
who fail to call
and reschedule.

The US Food and Drug Administration (FDA) approved the first generic version of
Wellbutrin
XL (Bupropion hydrochloride) extended-release tablets, which are indicated for
the treatment
of major depressive disorder (MDD).

FDA Approves First Generic Sertraline

As part of the Food and Drug Administration's (FDA) on-going efforts to increase
the
available generic drug alternatives for American consumers, the agency today
approved
the first generic version of Zoloft tablets (sertraline), as well as a liquid
concentrate
(sertraline hydrochloride) version of the product.

Sertraline tablets are indicated for the treatment of major depressive disorder
(MDD) in
adults and the liquid concentrate is approved for the treatment of MDD and some
anxiety
related disorders. In 2005, Zoloft was the sixth highest-selling brand-name drug
in the
United States, with retail sales totaling $2,561,069,000.

"Generic drugs are safe and effective alternatives to brand name prescription
products and
can provide for significant cost savings for the American public," said Gary J.
Buehler,
Director, Office of Generic Drugs. "Our office is committed to increasing the
number of
approved generic alternatives as quickly as possible."

The economic benefits of FDA's generic drug approval program are significant
because
generics can cost a fraction of the price of the brand name drugs and generic
drugs
represent about two-thirds of total prescription doses sold in the United States
in 2004,
according to IMS data on U.S. retail sales. Competition from generic drugs that
are safe
and effective alternatives may quickly lead to reductions in spending. The
savings would
likely increase as more competitors enter the market (See
http://www.fda.gov/cder/ogd/
generic_competition.htm).

FDA's Office of Generic Drugs (OGD) continues working expeditiously to review
and take
action on generic drug applications. For more information on other first generic
versions,
please see http://www.fda.gov/cder/ogd/approvals/1stgen0506.htm.

For additional information related to FDA's Office of Generic Drugs, please go
to: http://
www.fda.gov/cder/consumerinfo/generic_equivalence.htm.

Publication of Surgeon General's Report, The Health Consequences of Involuntary
Exposure to Tobacco Smoke

The Surgeon General's report, The Health Consequences of Involuntary Exposure to
Tobacco Smoke (1), was released on June 27, 2006. The report is an evaluation
and
synthesis of evidence regarding the health effects of exposure to secondhand
smoke. An
update of the 1986 report, The Health Consequences of Involuntary Smoking, the
report
also adds information regarding secondhand smoke to the smoking and health
database
developed for the 2004 report, The Health Consequences of Smoking; the database
is
available at http://www.cdc.gov/tobacco.

The six major conclusions of the latest report are as follows:

-Secondhand smoke causes premature death and disease in children and in adults
who do
not smoke.

-Children exposed to secondhand smoke are at an increased risk for sudden infant
death
syndrome (SIDS), acute respiratory infections, ear problems, and more severe
asthma.

-Smoking by parents causes respiratory symptoms and slows lung growth in their
children.

-Exposure of adults to secondhand smoke has immediate adverse effects on the
cardiovascular system and causes coronary heart disease and lung cancer.

-The scientific evidence indicates that there is no risk-free level of exposure
to
secondhand smoke.

-Many millions of Americans, both children and adults, are still exposed to
secondhand
smoke in their homes and workplaces despite substantial progress in tobacco
control.

Eliminating smoking in indoor spaces fully protects nonsmokers from exposure to
secondhand smoke. Separating smokers from nonsmokers, cleaning the air, and
ventilating buildings cannot eliminate exposures of nonsmokers to secondhand
smoke.

The Center for Disease Control has issued the following recommendations for
influenze
vaccinations. Stay Healthy!

In the United States, epidemics of influenza typically occur during the winter
months and
have been associated with an average of approximately 36,000 deaths per year in
the
United States during 1990--1999 (1). Influenza viruses cause disease among all
age
groups (2--4). Rates of infection are highest among children, but rates of
serious illness
and death are highest among persons aged >65 years, children aged <2 years, and
persons of any age who have medical conditions that place them at increased risk
for
complications from influenza (2,5--7).

Influenza vaccination is the primary method for preventing influenza and its
severe
complications. As indicated in this report from the Advisory Committee on
Immunization
Practices (ACIP), annual influenza vaccination is now recommended for the
following
groups (Box):

persons at high risk for influenza-related complications and severe disease,
including
--- children aged 6--59 months,
--- pregnant women,
--- persons aged >50 years,
--- persons of any age with certain chronic medical conditions; and
persons who live with or care for persons at high risk, including
--- household contacts who have frequent contact with persons at high risk and
who can
transmit influenza to those persons at high risk and
--- health-care workers.

I had a recent battle with depression/ insanity. ( a month or so ago,
back to "normal" since). Like a week long, filled with paranoia,
everyone hates me, thoughts of drinking again (sober 4 years in AA)
and some suicidal thoughts, but, not really. More like unplanned
fantasies of it with no real intentions but just feeling seriously
detached from myself in a way that was a bit scary. Hopeless. I was
still able to maintain some balance in terms of helping my AA sponsees
and working but I wrote a few frantic letters and all that. My
therapist, friends and some family think I would benefit from
medication so I saw a psychiatrist and he gave a very small amount (5
mg) of Lexapro. Although they may be right, I still have an aversion
to taking it and have yet to. My plan was to start tomorrow. The
psychiatrist only asked me very broad questions over 30 minute period
of time, took no medical history (allergies, anything) and sort of
just opened up his closet and pulled out some pills. I stated I had no
insurance so he offered to give me samples every two weeks for $50 a
visit. I guess this is standard practice, that's what everyone says. I
may have previously filled out a health form with my medical history
but I don't recall, he never made reference to it. This is someone
everyone recommended for meds. I just think it should be a bit more
involved for such a big thing but I guess maybe meds aren't a big
thing? I have had a low grade depression with a sort of paranoia side
to it for years so I could benefit from them. Any feedback?


-------------------------------

I can't tell from what you've said that the psychiatrist is doing
anything wrong - it actually sounds like he's doing fine. He should be
seeing you every week or two until you are doing better, and offering
to get you medication for free because you can't afford it seems very
generous.

Meds are a very big thing and so is your mental health. I encourage
you to stay in therapy, keep working on your problems, and bring up
these concerns with your therapist and psychiatrist.

If you live in America, you need to get some health insurance! You are
risking your health by not having access to the American health
system, which is VERY expensive without insurance.

DrG

As the season's first ice storm approaches, I thought I'd post the
winter weather policy for my office.

If Richardson Public Schools are closed, you may assume that my office
is also closed. No cancellation fees will be charged for any sessions
scheduled on a day when Richardson Public Schools are closed for any
part of the day. However, there is still a very good chance that I
will be in the office anyway, so if you'd like to keep your
appointment on a school closing day, please call the office first
thing in the morning - we may be able to move your appointment earlier
in the day.

If Richardson Public Schools are not in session (holidays and
vacations), but winter weather is occurring, please call the office
first thing in the morning to confirm your appointment. If my office
is closed, I will record a voice mail to that effect.

If Richardson Public Schools are NOT closed, you may assume that my
office is open and appointments will be kept. Cancellation fees will
apply, but will be waived for special curcumstances. If there is any
winter weather in your area, please use your own judgement and
discretion before attempting to drive to an appointment.

To all;

Today, I changed the group to be "moderated". This means all posts
will go directly to me. From there, I'll choose questions or comments
to post to the group.

My goal is to provide general answers to common questions about mental
health.

Please be aware that any messages sent to this group may be
republished (without identifying information) by other forums and
means, including electronic, print, and audio-visual.

Thank you for being a member of the cybercouch group.


Thomas A Grugle, MD