Here are some solid resources (to keep things in perspective):

The Centers For Disease Control (CDC) and World Health Organization (WHO) are the2 biggies; I prefer the CDC site, it just is more clearly laid out to my eyes.

These give you real-time updates on the state of the 2009 H1N1 influenza (it’s no longer formally referred to as “swine flu” for various reasons), including number of cases overall, and how many have been diagnosed in which states. As of the time of this writing (and it changes from day to day, or even hourly), there are 193 cases confirmed in California, and 3 recorded deaths in the U.S.

To put that last statistic in perspective, the regular influenza “Flu” causes about 36,000 deaths in America, each and every year. So far, the lethality impact of H1N1 has been much less; if it doesn’t mutate into a worse form, this Winter’s flu season may be no worse than usual.

The $65,000 Question

What public health authorities are focusing on, however, is what will happen over the next 6 months.

The current form of the virus seems to require fairly close contact to transmit, and responds to 2 widely available antiviral drugs (Tamiflu and Relenza, which are currently recommended only for use in severe infections, NOT casually — the last thing we want is for the virus to become resistant due to overuse of these meds!); the mortality rate is something on the order of about 1-2%.

Other viral influenza types exist, however, which could potentially mix with H1N1 to create a different strain. For example, H5N1 “bird” flu, very difficult to pass from person to person (it’s passed by direct contact with infected poultry), has an approximately 60% mortality rate. A mix and match of these two viruses would be absolutely no fun at all.

A very widespread global footprint of the current H1N1 strain is already happening, and is likely to qualify as a pandemic, which refers not to an infection’s seriousness, but to how far and wide it spreads. Work has already begun on developing a vaccine for the Fall/Winter, which even if isn’t an exact match for what comes back around in several months, should still confer some immunity to what until now has never been seen among humans.

With no natural human resistance to 2009 H1N1, scientists are very interested about what form it develops into.

What You Can Do

At this time, even though the virus is spreading, its numbers are mainly of academic interest. A sad fact: more people will die on the roads of California this week than have died in the whole U.S. during the entire course of this infection; focusing on the hundreds or thousands of mild cases will just drive you bonkers. You can keep track of locally identified cases by county, in the news or via a Google search online, if it would change your basic travel or school attendance habits.

If you’re going to focus on anything, focus on announcements from the CDC about any changes in the virus — particularly if it sounds like it has mutated into an easier to spread or more lethal form. If it happens, it will likely occur months from now, and overseas. And it may not happen at all.

There is no vaccine as of yet, but there should be by the time of the usual flu shot in September. Keep an ear out for it, as well as any recommendations for its use (it may or may not be recommended universally, or for people with certain health conditions).

Keep in mind the basic symptoms of a viral respiratory infection — fever, cough, aches, malaise — and discuss with your doctor what to do if you get them. Chances are, it’s NOT H1N1, but call your doctor to discuss your symptoms, especially if they’re worsening.

Under the heading of sensible medical advice in general, remember the cardinal rules (see the CDC site for more information):

• If you’re sick, stay home and call your doctor. Puh-lease don’t share your germs with coworkers, schoolmates, or your children’s playmates.
• Wash your hands with soap and hot/warm water, often. Especially after touching high-traffic surfaces in public places. Singing the alphabet song, “A-B-C-D…tell me what you THINK of ME,” at a child’s pace takes about 20 seconds, the recommended washing time, and don’t forget under and around your nails. Use hand sanitizer gel or foam if you’re not near a washbasin.
• In public areas, avoid touching your eyes, mouth, or nose. Germs on surfaces enter your body mainly through these sites.
• Cough or sneeze into your shoulder or sleeve, as a courtesy to others. If coming down with something, even if it feels like a little cold, avoid coughing or sneezing or wiping your nose in public. If you must be somewhere public, especially if you’re feeling worse, consider wearing a mask.

Most important of all, don’t panic.

Be attentive, stay healthy, and focus on what you already know you should be doing “when something’s going around.”

But from a medical standpoint, antibiotics aren’t widely recommended. They often don’t work at all for common infections, and can even cause harm in the long run.

What Causes Upper Respiratory Tract Infections?

Coughs and colds are commonly referred to as upper respiratory tract infections, and can be caused by two types of germs: bacteria and viruses.

Viral upper respiratory infections and bacterial rhinosinusitis infections often have similar symptoms, such as coughing, head and chest congestion, and mucus or phlegm that can be clear or yellow-green. Especially when phlegm goes from clear to green, you might think antibiotics are required to cure the infection.

But Antibiotics Fight Bacterial Infections

Antibiotics are medicines that stop an infection caused by bacteria, which are germs that cause illnesses such as strep throat, pneumonia and some sinus and ear infections.

However, antibiotics do not work against infections caused by viruses. And most coughs, colds and sore throats are caused by a virus.

For example, treatment of a sinus infection with antibiotics during the first week of symptoms is not recommended, because the infection typically is not bacterial at that point.

A diagnosis of bacterial sinus infection may be made in children and adults with symptoms of a viral upper respiratory infection that have not improved after 10 days, or that worsen after five to seven days. Patients may have some or all of the following symptoms:

• nasal drainage
• nasal congestion
• facial pressure or pain
• postnasal drainage
• fever
• cough
• feeling tired
• tooth ache or pain
• ear pressure or sensation of fullness

How Do Antibiotics Work?

Even in bacterial infections where antibiotics should be taken, it’s possible to use them incorectly.

Antibiotics kill off the weaker germs the first few times you take them. At first you start to feel better. However, the stronger germs are still alive. If you stop taking the antibiotics too soon (as soon as you start to feel better) the stronger germs can keep growing. If you do this, soon the antibiotics won’t work anymore, a phenomenon known as antibiotic resistance.

When this occurs, germs that can’t be killed by antibiotics can sometimes take over when all of the weaker germs are killed. It can happen when you take the same antibiotic too many times, or when germs are left over in your body after you have been taking these medications incompletely. When this happens you may need a stronger antibiotic. Some kinds of resistant bacteria are so strong that no antibiotic will work.

Neither you nor your doctor wants to get familiar with antibiotic resistance.

Preventing Antibiotic Resistance

Remember the 3 cardinal rules:

1. You should use antibiotics only when your doctor prescribes them.
2. They should not be shared with anyone else.
3. Don’t stop taking the medication too soon, and take it exactly as your doctor tells you to.

Patients who have symptoms of “common cold” as discussed earlier should start with adequate fluid intake, rest, humidified air and over-the-counter analgesics such as Tylenol for fever and body aches.

Some medications such as decongestants, antihistamines or cough suppressants may not be appropriate for some patients, so consult your physician before taking them. If symptoms do not improve in 10 days or worsen after 5 to 7 days consult your physician. Even if antibiotics are prescribed and you do not respond after 72 hours, further reevaluation may be needed.

There is a time and place for antibiotics. Use them properly, and they will continue to work well when you really need them the most.

It’s hard getting good health insurance, and when you do, it can be harder finding a good doctor.

You may be lucky enough to get a recommendation from a trusted friend or family member. But usually you’re stuck having to choose someone from a list.

Then you make your appointment, patiently wait to be seen, and when the moment comes to start talking to your doctor, you only get 15 minutes!

Most doctors’ offices offer extended appointments (we do!), but they are usually reserved for specific patient circumstances.

So how do you really get your money’s worth within 15 minutes?

1. Choose your doctor carefully

Familiarize yourself with the scope of his or her practice.

What does this mean? Find out about their specialty.

This is important because not all Primary Care Physicians — the doctors you go to for the majority of your health care needs and questions — have the same training.

Physicians who are board certified in Internal Medicine can offer care to all people over the age of 18 but do not attend to Gynecologic problems.

Physicians who are board certified in Family Medicine are trained to diagnose and treat patients of all ages, and can also see women for routine obstetrical and gynecologic problems (note: in urban and suburban areas, many family physicians do not follow women during pregnancy or perform deliveries, due to the widespread availability of OB/Gyn’s). The ability to attend to emotional, behavioral or psychiatric problems depends on the individual physician’s comfort level and residency training.

You can find out online or by phone, what your doctor’s specialty is, and if they have any subspecialty training (like Sports Medicine or Geriatrics) and if there are any specific problems they do not attend to in their office (for example, drug addiction or psychiatric illness).

This will help you to adjust your expectations of what you doctor can do for you that day or in the long run.

2. Make Notes

It doesn’t matter if you are 21 or 71, we all forget something as soon as we walk in the door. There’s something about being in a doctor’s office that makes most of us feel a little nervous- it’s even happened to me!

So write it down and then prioritize.

Decide which issues are pressing, and which ones can wait for a later appointment.

Always ask the doctor to explain things in terms you can understand, so you can write it all down and then go home to educate yourself — and maybe discuss with family, friends or another physician.

3. Remember: You Are Responsible For Your Health!

You have to be honest and straightforward.

When you lie or omit facts about your history or current symptoms, you limit your doctor’s ability to properly diagnose you — and therefore jeopardize your health. You might also be wasting your own time and money, because tests or studies might be ordered unnecessarily based on your incorrect information (or conversely, crucial tests not ordered at all).

Please understand we are trained to be objective observers, and to not let our personal judgment, biases or opinions interfere with giving you the best care. We all have our faults, but our job carries a great burden and we know you are very vulnerable when you walk through that door.

So please tell us the whole story, pretty or not! That includes family history, past surgeries, hospital stays, sexual health history, alcohol, smoking or drug use, and emotional problems or psychiatric illness.

4. Enlist Yourself As Part Of Your Health Care Team

What I mean by this is: take charge of your life and your health!

Ask your doctor for treatment options and referrals to information sources. Also, don’t be afraid to ask for a second opinion. We won’t take it personally, really!

If you know you will need more than 15 minutes, make sure to get your appointment time adjusted for that.

Ultimately it is your decision to follow you doctor’s advice but make sure you understand the pros and cons of doing so and are willing to take whatever risks come with that decision.

I hope you take the step today to make your appointment with your doctor knowing you have the tools to make it a productive meeting for both of you!

This post, here, is one of them.

Kathryn Woodall’s blog, A Comfortable Soul: Creating balance in your life, discusses matters pertaining to health and exercise. Health and wellness are big themes, there, but more from the inside out.

Less, “Do this exercise 12 times in 4 minutes,” than, “Put health first in your training, as well as your life.”

A nicer definition of Health, and what we should all be shooting for, I haven’t read in a long while.

Especially if you have issues with weight, or blood pressure, or cholesterol, you’ve probably heard us recommend changes in diet and exercise:

• Reduce your intake of saturated fats
• REALLY cut back on your starchy carbs, and up your intake of colorful fruits and vegetables
• Exercise more regularly, at least 3 times a week
• Get the down to a healthy body weight

These recommendations are key, and if you can adopt them, a good many of your health woes will either disappear, throttle way back, or not occur to begin with.

But if it were that easy, everyone would be doing it…and Big Pharma would be out of a job.

Here’s a link to a related website, to help you stick it to ‘em, and get healthier in the process:

An Apple A Day…To Keep Big Pharma Away

Mark’s Daily Apple is one of my favorites. Mark Sisson updates his blog on a regular basis, with an easy to read and accessible writing style. Most of his posts pertain to nutritional choices, with a heavy bias towards minimizing carbs, and increasing your intake of anti-oxidant rich veggies and fruits, and non-hormonally laden meats. His Primal Blueprint and Primal Eating Plan articles outline his core approach: an overall lifestyle of sensible activity, clean nutritional choices, and adequate recovery and stress reduction.

The “primal” or “paleo” approach focuses on choices that should complement the way human beings are made. We’ve only been couch potatoes, cubicle dwellers, and drive everywhere folks for the past century or so — for the vast majority of human history, we’ve been active walkers, occasionally kicking it into high gear to run, fight, build, or otherwise really work, and eating mainly lean proteins (with occasional healthy fats) and low-starch vegetables and the occasional low-sugar fruit. Grains — what most of our meals are often based on — became widespread with agriculture, which is only a few thousand years old, at best.

Mark’s site does NOT advocate a return to dwelling in caves, however. We live in the modern world, but can make healthier nutritional and activity choices than the ones that are routinely made for us. Sisson clearly states the reasoning behind his recommendations, so you can consider them for yourself.

Although I don’t entirely agree with his feelings about statin drugs to lower cholesterol (read, “Big Pharma conspiracy”), it’s hard to find fault with his basic recommendations, which parallel the Top 4 I mentioned at the beginning of this article. You could do a lot worse than to jumpstart your quest for health with his articles as food for thought, so to speak.

“Oh, and by the way…what does D.O. stand for?”

I’ve been asked this several times since starting my practice, usually at the end of a patient visit. It’s time to answer this common question about a doctor’s credentials.

“D.O.” stands for Doctor of Osteopathic Medicine, the “other” fully licensed and certified medical degree in the United States (“M.D.” or “Medical Doctor” being the more commonly known one).

The profession was founded by Dr. Andrew Taylor Still, a Civil War physician from Kansas who started first school of osteopathic medicine in Kirksville, Missouri in 1892. This degree is now awarded by 20 independent four-year osteopathic medical schools located around the country, two of which are here in California. After medical school, most D.O.s then choose several additional years of training in their chosen specialty, exactly like their M.D. counterparts.

D.O.s practice the full range of medical specialties, from anesthesiology to urology, and are fully licensed by hospital, state, federal, military, and medical board certifying agencies.

Osteopathic physicians also obtain extra training in Osteopathic Manipulative Medicine, which emphasizes the connection between the structure and function of the various systems in the body.

• This differs from chiropractics by being an holistic, medically-based approach to care that integrates the natural healing capability of the body.
• D.O.s are always mindful of the body’s capacity for self-healing, and continually use it as a part of diagnosis and treatment.

To find out more about osteopathic and general family medical care, call for an appointment with me: (714) 668-2500.

[This is Part 5 of a 7 part series. -- PK]

5. See Your Doctor Periodically

Well, you should have seen that one coming.

But seriously, there are some excellent reasons to make an annual physical a cornerstone of your plan for health. Overcoming your dread of the gloved finger, or the mammography squish, will pay you enormous dividends with the very first problem you let your doctor catch early.

Don’t Become A Statistic

A physician can check you for hidden problems long before they become obvious to you, at a stage when they can be better treated, or even cured. “I feel fine, therefore I must be fine” is generally right, until it is tragically wrong, wrong, wrong.

In college logic or rhetoric classes, this is called the inductive, or “black swan” fallacy: I’ve never seen a black swan, so there can’t be any such things as black swans, right?

It’s natural to think this way, but the health analogy sounds dangerously silly: I’ve never died, so I must be immortal, right?

You don’t want your body to break down, or to die before your time. But your odds start getting icky around your mid-30’s, just a bit. By your 40’s they’re noticeably starting to register in Vegas, and by your 50’s no one would be terribly surprised if you had a heart attack. 60 plus, and you should have been actively hunting for cancer for some time. Face it: this is simply statistical reality.

To shave those odds in your favor, you want to do some of the basics that I’ve alluded to (and that my colleagues and I are addressing in this series of blog posts). But seeing a doctor annually, specifically for a dedicated, “We are here today to systematically check you out” physical, should be a basic part of that.

It’s by no means a guarantee of immortality — in fact, the odds of picking up every single potential cancer and life threatening condition are kind of low, which makes sense, if you think about it.

But without that annual physical, the odds essentially drop to sheer dumb luck, which is to say, nearly zero.

Get By Pretty Well, With A Little Help From Your Friends

Second, a physician can advise you on the newest developments in medicine.

Lest you think that last one is a joke, consider this: in this new millennium, the docs who will “rise to the top of the cream” will be adept at sorting the wheat from the chaff, at Internet-search speeds and with quick email replies.

For example, the largest study to date — with nearly sixteen thousand participants — demonstrates an all-cause mortality reduction of up to 70% from exercise. Conventional wisdom said that staying active was good for you, but decades of study actually didn’t dramatically show that; you might enjoy life more, but not necessarily live longer.

This VA study, released earlier this year, showed reductions across the board in death causes, cardiac and otherwise, of about 13% per MET of increased activity (resting quietly is about 1 MET, stretching or Hatha yoga about 2.5 [as is straightening up around the house], walking the dog is 3, jogging is 7, running a 10 minute mile is 10, general weight training is 6, circuit training is 8).

Casual jogging, in other words, can reduce your risk of dying by about 50%, compared to being a couch potato.

There are tons of other nifty medical nugget examples, like the acai fruit being the most antioxidant rich food (not blueberries), or muscle aches being reduced post workout by berry juice drinks, or influenza being lethal to 14 World Trade Centers worth of Americans each and every year.

All of which the New Physician of the 21st century will either know, or be able to advise you of, from the standpoint of a trained, constantly retraining, and cautious medical professional.

Most of us can recall an encounter with the vitamin aisle at the supermarket, pharmacy or health food store.

It can be a confusing, frustrating event.

Vitamin C for colds, vitamin B for energy, calcium for your bones…we can even have trouble recalling what certain supplements, like copper, are supposedly good for. And there are dozens of brand names to choose from.

I can certainly understand people’s cynicism about supplements, given all the conflicting news out there. Currently, there are no recommendations from the United States Preventive Services Task Force (USPSTF) on using dietary supplements to prevent such health conditions as heart disease or cancer.

However, there is plenty of data that supports supplementing our diet with certain vitamins to optimize health. This is especially true for people in certain high risk groups and those who are not following a healthy, well-balanced diet.

You Can Do It With Diet…Sort Of

First of all, we need to understand that vitamins and minerals are the building blocks of the healthy function of our bodies. Most people can obtain most of the necessary nutrients (including vitamins and minerals) from a healthy, well-balanced diet. This means we need to eat the following:

• at least 5 serving of fruits and vegetables
• produce belonging to all the major color groups – green, purple/blue, red, orange, yellows/white
• whole grains
• low-fat dairy products
• protein from safe plant and animal sources
• small doses of healthy fats

And all of these preferably every day to get all of the recommended requirements.

But while I may love fruits and vegetables, there’s simply no way I have the time to check off every item on that list every single day!

Topping Off Your Tank

So here are some basic guidelines to help you decide which, if any, vitamin supplement is right for you:

1. Women of childbearing age (read: menstruating) need folic acid, iron and calcium, regardless of whether they are trying to become pregnant. Good food sources of these include dark green leafy (and crunchy) vegetables, fortified grains and cereals, beans, red meat (lean cuts), certain animal organs and low-fat dairy products. Pregnant women should take a prenatal vitamin as well.

2. Older adults (men over 65 and peri or postmenopausal women) need extra calcium and vitamin D to strengthen their bones. Ask your doctor how much is right for you, but the usual recommended daily amount is 1000 mg of calcium and 400 units of Vitamin D (600 if you’re over 70).

3. Adults over 50 should consume extra vitamin B12 in the crystalline form (available in fortified foods and in supplements).

4. Children need adequate amounts of calcium and vitamin D, along with vitamin C and iron, to promote normal growth and development, and can easily obtain these from food sources. Unless a child has a chronic medical condition or consistently avoids food from one of the major food groups, there is no need to add a multivitamin. The addition of fluoride to drinking water varies by county here in California, so check with your child’s pediatrician before starting any vitamin supplement with fluoride.

5. Any person with a chronic medical condition should consult with their doctor before starting any vitamin or mineral supplements, to ensure there are no interactions with their medications or contraindications due to a health condition. However, there are several conditions that can benefit from dietary supplements, including macular degeneration and dementia. Talk to your doctor.

In conclusion, the majority of the adult population can get most of the recommended daily allowance of vitamins and minerals by eating as healthy as possible on a consistent basis. So, for most healthy, active adults, taking a multivitamin is safe and recommended but not necessary.

Always talk to your doctor before starting any supplement if you take any medication on a long term basis, or have a chronic medical illness. And if you still have more questions, you can read more on this topic at the Office of Dietary Supplements website, which is part of the National Institutes of Health.

I can’t exactly say that I’m a shining example of health.

As a physician and family man, I think I do okay: I exercise regularly, including martial arts at least twice a week, don’t smoke or drink, and try to moderate my stress levels (haw).

But I don’t weigh what I did when I was a high school senior, and drink more coffee to get through the day than I’d care to admit. I eat too many carbs, get too little sleep, and don’t eat enough organic food.

These may not sound like much, but they should.

Nevertheless, I can still recommend 4 of the most important ways to avoid an early grave, and have a fine old time doing it (there are 7, but the final 3 will be in the next post). Partly because I’ve seen a lot of people do it right and do it wrong. Partly because the medical field has seen a lot, and has the studies to back up the advice it’s trumpeting from the mountain tops.

But also because, hey, the advice is so sensible and my self-respect has increased enough that I’m finally adopting the following principles myself.

1. Don’t Be Stupid

Hopefully a no-brainer, the biggest bang for your health buck is to avoid the so-called “big sins of commission”:

• smoking
• drinking
• unprotected sex
• running with a bad crowd.

If you avoid these 4 things, you essentially eliminate the things most likely to kill you before the age of 40, and many of the things afterwards: car crashes involving alcohol, AIDS, death by violent confrontation, and heart disease and cancer.

2. Get At Least 8 Hours Of Sleep A Night

I’m going to bounce around a bit from the inarguable to the debatable, but trust me on this — you need those hours of rest and recovery, regularly.

Physicians are plenty guilty of disobeying this rule, but just because we’re stupid doesn’t mean you get to be. The quality of your waking hours depends on a foundation of sufficient sleep. Don’t get enough, and everything else is compromise, your body swapping out the good stuff for a patchwork of “hopefully good enough” stuff.

Think up three of the best qualities that you’d like to be. For me, they were being

1. Creative and insightful with work projects
2. Attentive, observant, and insightful — hard to put one over on
3. Benevolent and forgiving with family

Now remember how hard you had to work to simulate those qualities when you were tired and strung out.

You CAN function with a lack of sleep. But you shouldn’t let it be a habit, or you’ll have no reserves for when times really get tough.

3. Shake Your Groove Thing

Preferably daily, with variation, but at least thrice weekly, you’ve got to move your body through space.

The American College Of Sports Medicine recently revised its minimum activity recommendation: 30 minutes daily of brisk walking or its equivalent, or 20 minutes three times a week of running or its equivalent plus twice weekly strength training.

Please take a moment and think, if you actually come close to this.

There is, quite literally, an infinite variety of ways you can exercise your body — there are an infinite number of ways you can do just yoga, or vary a weight training regimen, or run, or do martial arts. I’ll be addressing what I’ve found to be especially efficient and beneficial ways in future posts, but suffice it to say, unless you live and work on a farm, you need to explore and discover for yourself, a personal bodywork modality that you can do for life.

4. Become A Food Nazi

Did anyone ever tell you, “Work out a lot, so you can eat whatever you want?”

It’s kind of true, but not really. Both from a weight reduction as well as a “maintaining a healthy you” standpoint, there’s no way around it: you have GOT to pay some serious attention to what you put in your mouth.

I love a Quarter Pounder With Cheese as much as the next person. And if I see another Olive Garden commercial at 9:30 PM, I’m going to fall down in a rabid, ravenous, late night fit.

But look around you. Count how many of the next 10 people walking by you on the street look overweight or obese. Unless you’re in Amish country or the Olympic Training Center, about 70-80% should be typical.

Obesity is arguably THE major health crisis facing Americans today, and as a physician who listens to some serious bodywork coaches who train the athletic elite, I can unequivocally say, if you are eating randomly and unmindfully, you are almost certainly doing it wrong.

And this isn’t even getting anywhere near such topics as food for cancer protection, mood preservation, longevity and libido, and exercise recovery.

There’s More To It

But for the time being, these are The Cardinal Four I want to direct your attention to: avoiding the deadly sins, resting deeply, staying active, and eating properly.

This is the four-legged table upon which further discussions of Health and Fitness rest. If any of these is missing, then the whole foundation gets weakened. You could make a strong case that Health can be attained by focusing on just these 4 issues. If you become serious in your search for better health, you’ll find, as I have, that you’ll keep encountering these 4 cornerstones again and again. They really are that critical.

Next time: the 3 Essentials For Higher Health.

More and more, the young women in my practice are asking about the Gardasil vaccine.

This vaccine was designed for women from 9 to 26 years old to prevent diseases caused by 4 types of the human papillomavirus (HPV).

HPV is a sexually transmitted virus that can cause a spectrum of diseases including precancerous cervical lesions, cervical cancer, and genital warts. There are more than 100 types of HPV, but the vaccine focuses on 4 “high risk” virus types that cause most cases of cervical cancer and genital warts.

To become immune, you’ll need 3 doses of the vaccine: the first one at the time of your choice, the second 2 months after the first dose, and the third 6 months after the first dose. Possible side effects associated with the vaccine include pain, swelling, or redness at the injection site, nausea, dizziness, or fever.

Unfortunately, many people who have HPV may not show any signs or symptoms, and can pass it to their partners during sexual intercourse. The main goal of the vaccine is to protect and prevent before you get exposed to HPV.

Many pediatricians are administering the Gardasil vaccine as part of the routine immunizations given at 11 years of age, with the consent of the parents, of course. Please note that if you already have HPV, this vaccine cannot be used for treatment.

However, having HPV does not mean you shouldn’t consider the vaccine, since Gardasil can protect you from the other virus types covered by the vaccine.

Even if you get the vaccine, I want to emphasize that all women still need regular pelvic exams and pap smears to screen for cervical cancer — since the vaccine, though very effective, does not cover all types of the HPV virus. Protected intercourse is also important to prevent all sexually transmitted infections.