As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From Scott, Oregon

“After suffering through the H1N1 flu for almost a week, I feel completely healthy, save for a lingering cough. There is not much if any mucous involved, it's just a sensation that makes me constantly want to clear my throat. I am a healthy 33 year old male with no chronic illness; no allergies and I have never smoked.”

Answer:

You are not alone, Scott. Persistent, nagging cough is a common complaint among people who contract the H1N1 virus, even healthy non-smokers like you. Some say that the cough lasts for days – sometimes weeks – after other overt symptoms like fever, nausea, fatigue and congestion go away.

It's sort of like having a house guest who has worn out their welcome.

So why does the cough stick around for so long? The H1N1 virus causes inflammation in the respiratory tract, which includes the back of the throat and bronchial tubes that branch out in the lungs. The virus attacks that lung tissue, causing irritation. So although you are not suffering from the flu any longer, irritation in the mucus membranes lining your respiratory tract is still healing, and that is manifesting as a cough you cannot shake.

Unfortunately, the best thing for you to do is wait it out. Your cough could be a bothersome symptom for another two or three weeks, but it should dissipate as your respiratory tract heals. There are some effective cough medicines out there available over the counter, and even stronger ones in prescription form, but the good news: this is likely to get better on its own.

Incidentally, residual cough is common with most flu, including seasonal strains. As long as you are fever-free and otherwise feel well, there is little chance that your cough is spreading the H1N1 virus. The incubation period for H1N1 – the time during which you are most infectious to others – is between one and seven days.

Of course if several weeks go by and the cough has not subsided, you may decide to visit your doctor.

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

Late last night, I finally finished reading the senate bill and the manager’s amendment. I will admit: it was tough to get through and took me back to my medical school days. At some point, I would love to know how many people have read it or understand it well enough to formulate a decision. That is not, however, where I want to go today.

Instead, I want to try and summarize the hundreds of blog comments I have received. It appears most people are in favor of addressing the access issues of the uninsured and the underinsured. Most seem to think that is a noble, worthwhile and perhaps even moral goal. The largest concerns seem to revolve around cost and concerns about the possibility of worse care.

More specifically, there were many comments about the increase in taxes necessary to pay for this. That will likely happen for a segment of the population making over a certain amount of money. That amount is still being debated. There is a plan to decrease Medicare spending by close to 500 billion over 10 years. Supporters say this will finally remove inefficiencies. Critics charge it will lead to worse care for seniors. There could be a tax on Cadillac health plans. If your plan costs more than $23,000 to cover your family – not what YOU pay, but the total cost of the policy, there will be a 40% excise tax on any amount over that $23,000 amount. No doubt, most agree it is going to cost a lot of money to insure 31 million more Americans.

One thing that hasn’t received as much attention is a term that could cause eye glaze, but is worth talking about.

Comparative effectiveness.

It is this idea that we pay too much for too little, and we should spend some time figuring out what really works with regard to health care. It is this idea that perhaps we over-test, over-prescribe and yes, perhaps perform too many procedures, and yet our health overall doesn’t reflect that higher overall spending.

It is this idea that if we spend some time really figuring out if knee surgery is in fact better than taking anti-inflammatories for arthritis, and to stop performing as many of these operations if it isn’t better. I am not picking on my orthopedic colleagues. The same can be said of operations in my specialty of neurosurgery, or really just about any aspect of our health care system. You may be surprised to know that we can’t always guarantee better health outcomes because more money was spent, a medication was prescribed or an operation was performed. The answer is not always that easy.

The rub is this: If comparative effectiveness data shows a particular procedure is not as effective as believed, it is possible insurance companies may be hesitant to cover it. Instead, you may get a letter stating the procedure is not warranted. Supporters of this will say this is a good strategy to reduce costs. Critics will use the R word: Rationing.

What do you think of comparative effectiveness? Does it have a place in this discussion? And, how do you think it will impact the physician – patient relationship?

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

As we continue this discussion, there are a few emerging themes. (read the Senate health care legislation) So, to keep the direction focused, I will try and take on one at a time.

The topic I would like to explore today is “personal responsibility.”

In many different ways, it seems you have questions about this topic. So, let me attempt to summarize it this way.

Will increasing access to health insurance make people more responsible about their health? Should it? And, will it improve their health overall? It is an important question to me as a doctor, because the measure I care most about is a healthier society, and the corresponding health of individuals.

There is no question that people who have unlimited resources, in terms of money and insurance, are often the unhealthiest of all. So, it would seem that access to health insurance alone does not equate to good health. On the other hand of course, over 40 million people don’t currently get a chance to test that theory.

Personal Responsibility.

How would you define the current obligation of any individual for their own health? And, if you would believe in the power of personal responsibility, how do we get better at it as a nation?

Programming Note: Tune into Larry King Live tonight at 9pm ET for a discussion about life after death. Can we come back from the dead? People who say they've done it say "yes"! Dr. Sanjay Gupta and Deepak Chopra take on the mystery of life after death – only on CNN at 9pm ET.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Dr. Sanjay Gupta
CNN Chief Medical Correspondent

Last night I was up late covering the senate vote on health care for CNN. The number of e-mails I was receiving while discussing this on air was staggering. I realized that as much as we talked about cloture and reconciliation, most people who didn’t read the 2,000+ page bill (which is most everyone) really wanted to know what this bill means for them. They didn’t care as much about the compromise that was struck by Sen. Ben Nelson, which would obligate the federal government to pick up the Medicaid tab for his state of Nebraska into perpetuity. They are still not sure if a public option is a good thing or not, and they aren’t sure how the exchange would work for them. In short, there is a collision of politics and health care, and sometime the impact on individuals gets a little lost in the shuffle. (Read the Senate health care legislation)

I want to use this blog as a platform to try and address some of your specific questions and to also throw out some key information that may have flown under the radar. I will start with a number. 2014. This is the year most of the provisions of the bill would kick in under this version of reform. That’s right – four years away. Many people think health care reform in binary terms. One moment there is a vote, and the next moment you have it. Many wish it were that easy. It is true that children may benefit earlier in some areas, but for the vast majority of the more than 40 million uninsured, things aren’t going to change significantly for a few years. And, speaking of the more than 40 million uninsured, this bill won’t impact all of them, but instead roughly 31 million.

So, let’s start here: Based on what you know about this bill, do you think you will be impacted? Has this affected your current plan, if, for example, you are working for a large corporation? What information is still lacking for you?

Click here to see Dr. Gupta answering some of your health care reform questions.

By Miriam Falco
CNN Medical Managing Editor

The Department of Health and Human Resources says as of Friday, December 18, more than 100 million doses of H1N1 flu vaccine will have been made available for states to distribute. This news comes at a time when the so-called swine flu seems to be waning in the United States. It was just a few short weeks ago when the H1N1 flu virus was widespread, in 48 states, and people lined up for hours just to get one of these vaccinations. Now at least four states – Wyoming, Colorado, South Dakota and Nebraska – are reporting "no activity" at all. This may lead many to think that the pandemic is over, that there's nothing to worry about any more. However health officials keep reminding us that flu is unpredictable and we're just now entering the earliest part of what is considered the beginning of a normal flu season.

Yesterday, health officials also announced the latest statistics on how many Americans were affected by H1N1. So far 47 million cases have been reported; nearly 213,000 hospitalizations; nearly 10,000 deaths; and five times more pediatric deaths than in a typical flu season.

Eight months after this global pandemic began, World Health Organization officials say that they are frequently asked whether the pandemic is over or another wave should be expected in late winter or early spring. "The answer is right now is that we simply are not able to answer this question," Dr. Keiji Fukuda, special adviser to the WHO's director-general on pandemic influenza, told reporters Thursday. He also said that even if the H1N1 flu seems to have peaked in North America, other countries such as Switzerland, France, Kazakhstan, Kyrgyzstan and Russia are seeing high activity.

Perhaps more eye-opening was that Fukuda's announcement that six manufacturers and 12 countries had pledged 180 million doses of H1N1 vaccine, which would go to about 95 countries. The WHO had hoped to distribute these vaccines in late November or December, but that has now slid to sometime in the next few weeks. So the U.S. will have been able to distribute more than half of the number of vaccine doses as the WHO hopes to distribute to 95 different countries, most which couldn't afford to buy them themselves.

The question in the U.S. is, with more vaccine becoming more easily available, but flu activity dramatically down compared with just a month or two ago, will people who haven’t been vaccinated yet or gotten sick still get a flu shot or nasal spray?

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From the Paging Dr. Gupta blog, Terry asks:

"I would love some advice on choosing a heart rate monitor."

Answer:

Well, it turns out, Terry; our folks at CNN.com gave some great advice on this. Advice that I paid attention to since I’ve been working hard this year to get in better shape and am now training for a triathlon as a part of CNN’s Fit Nation Challenge.

As I train, something I've been focusing on is heart rate target training. It's actually pretty simple to do. First of all, calculate your maximum heart rate. The way that you do that, you subtract your age from the number 220. So, mine would be 180. Now, you calculate a range between 60 percent and 70 percent of that number. Mine would be from 108 to 126. Try and keep your pulse rate in that range while you work out. A heart rate monitor is a simple device to help you calculate your target heart rate and keep track of your workouts so you can measure your progress.

So Terry here is a rundown of heart rate monitors depending on what you’re looking for and how much you want to spend. There are a lot of monitors out there. New monitors are equipped with GPS, speed calculating shoe sensors and data analysis tracking every detail of your performance over time.

So, the experts CNN.com quoted said the new Garmin Forerunner 310XT is the optimal choice, but it is very expensive. It's almost $350. It does work anywhere in the world and you can get your heart rate, measure movement, elevation, distance and speed. Now, if you're looking for something more affordable, like a lot of people, Nike offers a slim watch size unit called the Nike Plus Sport Band. It runs about $59 and displays your distance, pace and calories burned. It holds about 30 hours worth of workout data. Check out more options at CNN.com/technology.

Keep in mind the longer your keep your body at that target heart rate I talked about, the more efficient your cardiovascular system will become, and overall, the fitter you will be. Good luck Terry hopefully tracking your heart rate will help you make your workouts even better.

By Val Willingham
CNN Medical Producer

On November 21, Senior Airman Tre Porfirio was struck in the gut by three high velocity bullets while serving in Afghanistan. Porfirio, from St. Mary's, Georgia, was seriously injured; his entire digestive system was in danger of shutting down. During two operations in combat hospitals, surgeons removed his gallbladder along with portions of his large and small intestines, part of his stomach and a large section of his pancreas.
Porfirio was flown back to the United States immediately after emergency surgery, and taken to Walter Reed Army Medical Center, in Washington, D.C.

Col. Craig Shriver, chief of general surgery at Walter Reed, knew he had to remove the airman's remaining pancreas, which was found to be damaged beyond repair. "The optimal procedure at this point was to remove his entire remaining pancreas to prevent further leakage of the pancreatic enzymes and control the bleeding, which could be fatal," said Shriver. "We knew that the procedure would lead to the most severe and life-threatening form of diabetes, which tends to be very brittle and difficult to control in this type of situation.”

In an effort to save Porfirio from severe diabetes, Shriver turned to other surgeons for suggestions. Dr. Rahul Jindal, a transplant surgeon also at Walter Reed, had training and experience in islet cell transplantation, which is considered the best hope for curing diabetes. In islet cell transplantation, the insulin-producing islets are taken from a donor pancreas, treated and then put in the patient's liver where they begin to produce insulin for the body, even if there is no pancreas. In this case, the islet cells would come from Porfirio's own pancreas.

"Isolation and purification of pancreatic islets is a very intricate procedure, which requires a specialized laboratory, and there are only a few such facilities in the United States," said Jindal.

But Jindal knew of the perfect facility for the job; he turned for help to the Diabetes Research Institute at the University of Miami Miller School of Medicine. The director of the institute, Dr. Camillio Ricordi, developed the method for isolating the islet cells from the pancreas and was considered a pioneer in the field. Ricordi immediately agreed to help, noting that he would do "anything to help a wounded warrior."

Doctors at Walter Reed then proceeded to remove the remaining portion of Porfirio’s pancreas, packed it in ice and sent it to Miami.

On Thanksgiving Day, just five days after Porfirio's initial injury, the cell processing team at the Diabetes Research Institute spent six hours performing the islet cell isolation and purification procedure. "More than 220,000 purified islets were then suspended in a specialized cold solution and flown back to Walter Reed,” said Ricordi.

That afternoon, on that very same Thanksgiving Day, the islet cells were injected into Porfirio’s liver with Ricordi and his team coordinating the procedure with surgeons at Walter Reed via an Internet connection, a sort of high-tech telemedicine event.

In the three weeks since being wounded in Afghanistan, Porfirio has undergone 11 surgeries and, according to doctors, is "doing well." In a press conference held Tuesday at Walter Reed Medical Center, surgeons noted that there was evidence of the airman’s islet cells functioning in his liver less than one week after surgery; 15 days after the procedure, the transplanted islet cells were functioning in the normal range. His physicians say as time goes on, the islet cells in the liver will get stronger; when that happens, Porfirio's insulin requirement is expected to decrease. And although he'll still have a form of diabetes, the complication won't be as dangerous and he'll have a better quality of life.

Doctors from both the University of Miami Miller School of Medicine and surgeons at Walter Reed believe this transplantation is the first of its kind in a wounded soldier. They hope the success of the procedure will allow for more cases of islet cell transplantation in military personnel, as more of our fighting men and women return from war with injuries like those of Senior Airman Porfirio.

By Ashley J. WennersHerron
CNN Medical News Intern

A friend and colleague of mine died in July, from injuries she suffered when she was hit by a delivery van in Ocean City, New Jersey. Casey A. Feldman was a 21-year-old student with a promising future in journalism, balancing a full course load, an internship and the job of news editor for our school paper. Her family recently endowed a scholarship for communications students, so that others will have the opportunity to intern without monetary worries. Few people applied, despite a simple application, requiring only a recommendation, resume and a 200-word personal statement.

I applied, but I didn’t want to. Only a true need for financial aid (and my mom’s encouragement) pushed me to fill out the application. It sounds irrational, but I do not want to take money that could be going to the girl I knew. Nearly five months after her death, I want the money to be waiting for her and I would feel guilty if I won the scholarship. It feels wrong and disloyal to gain profit from Casey’s death, yet she would want others to have the opportunity to explore internship options and career choices.

It’s survivor’s guilt.

People who lose someone tend to find that, in their grief, they experience a sense of powerlessness. This complete lack of control, in all facets of life, stems from our emotional worlds toppling from the loss.

“When we lose our grandparents, we lose our past,” said Diana Nash, a psychology professor at Marymount Manhattan College and a bereavement counselor. “When we lose a sibling or a peer, we lose our present. If we lose our children, we lose our future.”

The idea of losing my present struck a profound and terrifyingly accurate chord for me. The comfy, college bubble of carefree immortality had been yanked away, leaving an acute void. Where I was once planning and daydreaming about my future, I began simply hoping there will be a future for me and wondering why Casey and her family didn’t get to keep their dreams.

The world loses logic when someone dies suddenly. I entered a mode of complete reaction. I couldn’t actively make decisions or plans — everything I did was in reaction to things around me. I felt as if I had no control at all.

The scholarship was something I had some say in. I could decide to apply, or not to apply. It was my decision, I thought, until I realized how difficult it was to make. Nash explained that even the scholarship itself is a plan for the future, something that was just proven hazy. It’s instinctual to avoid exposing yourself to a situation closely related to the experience that just caused so much suffering. The scholarship is a happy thing in itself, but it is also another manifestation that Casey is still gone, and the guilt doesn’t bring her back.

Have you experienced guilt after the death of a loved one? How did you come to terms with it?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Theresa Tamkins
Executive Editor, Health.com

Oh, Mr. Squiggles. You’ve broken more women’s hearts this year than Tiger Woods. Never heard of Mr. Squiggles? Either you’re lucky or, more likely, you don’t have anyone under 12 in your social circle. For the uninitiated, Mr. Squiggles is the hot toy of 2009.

Mr. Squiggles is a little robotic hamster that scurries around, rides a skateboard, rolls around in a hamster ball, and is just as cute as the real version—without the offending smell, cage cleaning, and tendency to bite small fingers.

At a cost of $8 to $10 each, what’s not to love? Mr. Squiggles, you had us – me and my 8-year-old who started crying for you back in August – at the hamster version of hello. And here’s where the heartbreak starts.

You can’t find Mr. Squiggles (he’s the brown one) anywhere. And don't bother looking for his pals Num Nums (gray), PipSqueak (yellow), or the white one (I can never remember its name) either.  These little fellows, collectively known as Zhu Zhu Pets have been sold out at Target, Walmart.com, and Toys"R"Us for ages.

Mr. Squiggles’s stardom means he’s traveling in more rarified circles now. For example, you can find him at amazon.com – at times for $70 or more. Or check out eBay, where a bunch of boobs – like me – are furiously bidding on hundreds of the robotic rodents.

That’s right. Me, who scoffed at desperate parents in the past and has been known to lovingly croon to her children, “You can’t always get what you want…” snuck onto eBay late at night – night after night – to watch the bidding madness.

And finally I pounced – and scored! – a Mr. Squiggles. And it was only about two to three times the original cost.

But the heartbreak just keeps coming. A mere 12 hours later, I discovered Mr. Squiggles might be a toxic toy, potentially contaminated with antimony, according to a report from consumer group Good Guide. Oh, how you crush me, Mr. Squiggles!

Part of me felt like the toy would have to be made out of salmonella-coated plutonium to deter me from my desperate quest. (Did I mention that it included having a second cousin who lives three states away scout out her local stores – unsuccessfully? Thanks for trying, Michele!).

But I thought I’d better dig deeper. Is Mr. Squiggles bad for us? Really? (Meaning our physical, as opposed to mental, health.) In a hastily posted note on Monday (which originally misspelled “hamster,” but was later corrected), Good Guide clarified that it tests toys using a technology called XRF technology, which is different from that used by government regulators.

The Zhu Zhu Pets manufacturer, St. Louis-based Cepia LLC, issued a statement saying “Test results show Mr. Squiggles, as well as all other Zhu Zhu Pets products, are well within U.S. government standards and these results have been certified by the world’s leading independent testing organizations.”

And the Toy Industry Association, which represents toy makers, also issued a statement saying XRF “has not been determined to be a reliable test method overall,” by the U.S. Consumer Product Safety Commission.

“Parents can be assured that things that are on the store shelves do comply with our very strict federal standards,” says TIA’s Adrienne Citrin.

Good Guide eventually issued a correction, saying that Mr. Squiggles was safe after all. Apparently it was all just a horrible mistake.

That’s nice. But between greedy jerks buying up every available toy just to charge parents exorbitant prices online (yes, it’s capitalism, but I don’t have to like it), and mixed up toy testers, I just don’t feel the same about you, Mr. Squiggles.

A bit of a holiday mood killer. What do you think?

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From Cyrus in Pittsburgh:

“Can obesity be linked to Alzheimer's disease? And can physical activity help ward off the disease?”

Answer:

There are two important questions here. The quick answer, of course, is yes. But obesity, as you might imagine, is just one part of the whole puzzle. First, most things that are bad for your heart are often bad for your brain as well. That’s one way to think about it. You see, it's all about blood flow. So what impedes or affects blood flow to the heart is generally going to cause the same in the brain. Elevated blood pressure, high triglycerides, and high cholesterol all affect blood flow and all increase your chances of developing Alzheimer's disease later in life.

The good news, to the second part of your question, is we know a lot about what we can do to prevent or delay the onset of this disease. Being physically active has been shown to improve mental function and to keep your brain healthier as you age. It's also essential for maintaining good blood flow and encouraging the growth of new brain cells. Studies show exercise that raises your heart rate for a minimum of 30 minutes several times a week seems to be the key. And exercise does so much more: It significantly reduces the risk of heart attack, stroke and diabetes. So stay active to keep your body and brain healthy for those later years.