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.

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?

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.

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.

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

CNN blogger, Beata, asks:

"Of those who have lived long lives, what is the common thread? What's the one thing I can do today that can make me live longer?"

Answer:

For well over a decade I've been investigating the answer to this question. The good news is there are actually a lot of small lifestyle changes you can make today that will add years to your life. For instance, flossing can add a year to your life – a whole year – just by adding to your daily routine. Turns out there's a pretty clear link between gum disease and heart disease. Flossing is your best bet at stopping that.

Here are a few more: A low-dose aspirin a day could add two years, and limiting your coffee intake to two cups a day could add another year. Simply checking blood pressure regularly could add one and a half years, and exercising three times a week could add three years. Cut work hours down to a manageable 40-50 hours a week and you add another one and a half years. Add it all up – and you have added a decade of functional life.

I will be the first to admit, it isn't always easy to practice what I preach, especially when it comes to the work-hour issue. But, we do know stress affects just about every part of our bodies. Our bodies simply start to shut down and become unable to tolerate the assault being placed on them every day.

Earlier this week I sat down with anti-aging expert Dan Buettner. He explores the world searching for longevity hotspots, known as blue zones, and looks for the lessons we can learn from them. One thing Buettner points out is that the people who live long lives in blue zones around the world are stressed out too. Yet they are still living disease free and often to 100 years old. The difference is they don't internalize their stress as most of us do. They all practice simple techniques to de-stress including praying, napping, even happy hour. Also meditating, which I have started, for 20 minutes every day and taking time for yourself every day can help.

In case you missed it, click here to hear more of my conversation with the world's leading anti-aging experts and get more tips to live a longer, healthier life.

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

From Connie in California:

"My family will be flying for the holidays. Should we be concerned about being in an enclosed space for five hours?"

Answer:

Connie, more than 2 million people are expected to be flying over this holiday weekend and many have the same concern as you. The Centers for Disease Control and Prevention points out there are not many studies about the spread of flu on airplanes, but anytime people are in close quarters the chance for germs spreading is much higher.

If you are sitting next to someone who is coughing excessively or seems ill, that’s when you are most at risk. According to researchers at Purdue University, you’re most likely to get sick from the people sitting in your row or the row behind you. They actually developed an animation showing how germs move around an airplane. If you’re in this situation, there are things you can do to lessen your risk of getting sick. Point the air vent away from yourself and towards the sick person – that may help push the germs back at that person. Also, turn your body away from the person who seems ill and as we’ve been saying – don’t touch your face. Dr. Julie Gerberding, the former director of the Centers for Disease Control and Prevention, adds that you could ask a flight attendant whether a mask could be given to that person or if that person or you could be moved to another part of the plane. Gerberding also points out that the air on planes is circulated through a HEPA filter, so if you are several rows away from a sick person you’re unlikely to catch his or her germs.

Keep in mind, you can go a long way in protecting yourself by taking some simple steps. I know we talk about this all the time, but wash your hands frequently with soap and water. If soap and water aren't available, you can carry those alcohol-based hand sanitizers. Cover your nose and mouth with a tissue while sneezing and encourage people around you to do the same thing and avoid touching your eyes, nose and mouth. We touch our hands to our faces a lot. In addition, some people might consider carrying a disposable mask, especially if you're feeling sick yourself. Finally, the CDC recommends that you get vaccinated, if you can. That’s sometimes harder than it sounds. For more information, check out flu.gov and CNN’s special report on H1N1.  Have a safe trip, Connie

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

From Elaine in New Jersey:

I attended a clinic this weekend for the H1N1 shots, and they administered the nasal spray to my 14-month-old! According to the CDC website it should NOT be administered to children under 2 years of age! I contacted the pharmacy where the clinic was held, and they took my contact info and said we will get back to me. Can you tell me is my child at risk?? I also have a call into my pediatrician. I also contact the CDC and was told they are not medical professionals.

Answer:

Elaine, it is easy to sense dismay and concern from your e-mail, and as a father I can certainly relate.

The reality is – yes – the nasal spray version of the H1N1 vaccine, which contains a weakened live flu virus, should be given only to people ages 2 to 49. We also know that children with conditions such as asthma may not be eligible for the live flu vaccine.

In order to ease your mind a bit, unless he or she has asthma, chances are very good that your 14-month-old will be fine.

The primary reason children younger than 2 do not get the nasal spray H1N1 vaccine is that it has not been tested in, and therefore is not licensed for, that age group. It is that simple. You need solid data to submit to the Food and Drug Administration before a medication can be approved for use in a particular population – that data do not exist for children younger than 24 months.

To ease your mind a bit more, rare complaints among adults and children taking the nasal spray form of the H1N1 vaccine are runny nose, sore throat, and sometimes fever. These symptoms usually go away within a couple of days. If they do crop up for your 14-month-old, you should not be too concerned, but if the symptoms get worse or your instinct tells you to, do see your pediatrician.

On the bright side of your predicament, your son or daughter is now vaccinated against H1N1. There are many parents who are still waiting to have their children vaccinated, so count yourself among the fortunate. Your child should soon have a second H1N1 vaccine dose – this time with the injectable form of the vaccine. And if you have not yet been vaccinated, you should do so – as the caregiver for your baby, you are eligible for these early doses of vaccine.

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

From Kali in Florida:

My 4-year-old daughter has egg and peanut allergies. Can she still take the H1N1 vaccine? If not what are her choices. I've been getting conflicting answers.

Answer:

Kali thanks for writing in. We’ve received several questions like yours since the H1N1 vaccine became available. Let me start by saying that if your daughter has a true egg allergy, and not just a sensitivity, then she can not have the H1N1 or the seasonal flu vaccine. The two types of H1N1 vaccine, the shot and the nasal spray, are made with eggs so it is not recommended for people with severe egg allergies.

However, allergists we spoke with said people with mild reactions to eggs can get vaccinated. Keep in mind that the amount of egg protein in a vaccine is often less than you would find in most baked goods. So if your daughter has been able to eat bread or cake, she may have a more mild allergy.

Consider going to an allergist and ask about getting a skin-prick test. The allergist will have a diluted and non-diluted version of the vaccine. Their first step will be to do the skin-prick test with the undiluted version. If your daughter does not break out in hives or have a strong reaction, then she can have a stronger test with a small, diluted injection. If your child doesn’t have a strong reaction to that test, then her allergy may not be severe and your allergist may give her a flu shot.

If your child does have a strong reaction and your doctor believes she shouldn’t get the flu shot, then talk with your health care provider about strategies for keeping her healthy. These steps are basic hygiene, such as washing hands for the count of singing the “Happy Birthday” song twice and staying away from sick friends plus, avoid wiping your eyes and touching your face if possible.

I hope this helps and your daughter has a flu-free season

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

From Robert in Kansas:

“I heard this week that the H1N1 virus has now turned up in pigs. Does this mean it can get into our food supply and I’ll get sick if I eat it?”

Answer:

Great question. The U.S. Department of Agriculture did recently announce that a commercial herd of pigs tested positive for swine flu. The USDA continues to stress that you will not infected with the HIN1 virus from eating pork. In fact, the infected pigs in Indiana weren’t destroyed. Once they recover from the flu, they will go to slaughter according to the USDA. Officials experimentally infected pigs earlier this year to see whether their blood and meat also became contaminated. They concluded that the H1N1 virus stayed contained in the respiratory tract of infected pigs and the virus did not infect the meat. The World Health Organization and World Organization for Animal Health have also concluded that humans can not be infected with the H1N1 virus from consuming pork. For more information about H1N1 and food safety, click here.

From Cheryl:

“While at my doctor's office, I asked about the H1N1 vaccine. I was told it will be very expensive, like $300. Since I do not have health insurance, the expense of the H1N1 vaccine will factor into whether I get it.”

Answer:

$300 is an excessive amount to pay for a free vaccine! That’s right – it’s free. The federal government has purchased the H1N1 vaccine and is shipping it out to states free of charge. They’re even picking up the tab for the syringes, needles, sharps containers, and alcohol swabs. Centers for Disease Control and Prevention has also stated private clinics may not charge patients a co-pay or other out-of-pocket charges for the vaccine. The only thing you should be paying is perhaps an administrative fee for your office visit but in many cases that fee is being waived as well. I would double check with your doctor again on the price. If the office still attempts to charge you $300, I would decline and instead contact your state’s health department to locate public clinic administering the vaccines near you. You can also track the vaccine’s shipments in your state through the CDC’s Web site. Check it out by clicking here.

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

From Shannon:

"I have a 4-month-old infant and I recently had myself and my 6-year-old son vaccinated for H1N1. My question is, will my infant also gain my immunity to H1N1 through my breast milk? I hope so." 

Answer:

This is a great question and a huge concern for many parents whose children are less than 6 months old and therefore too young to get the H1N1 vaccine. Unfortunately, there is no clear answer to your question, Shannon, so the best we can do is spell out what we do know.

We know that any time you breastfeed your 4-month-old, you pass on potent antibodies (proteins that your immune system produces to fend off disease in the body) that protect him or her against a whole range of infections.

We also know a bit about other vaccines and breast milk, for example, the pneumococcal vaccine that protects against things like pneumonia and meningitis. According to the National Institute of Allergy and Infectious Diseases, mothers who received that vaccine produced antibodies that were detectable in their breast milk, and passed them on to their babies. What is not as clear is whether those antibodies actually conferred immunity to their newborns.

The Centers for Disease Control and Prevention guidance about breast milk and the flu vaccine is a tinge more hopeful, albeit far from conclusive: "By breastfeeding, mothers can pass on to the infant the antibodies that their bodies make in response to the flu shots, which can reduce the infant's chances of getting sick with the flu."

While experts wrestle with this question, you have already taken a positive step – and significantly reduced your baby’s chances of getting the H1N1 virus – by getting yourself vaccinated. The next step is to create a "cocoon of protection" around your baby by making sure that other caregivers in the family also get vaccinated.

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

Question from Jane in Amsterdam:

"I fear having a stroke because I have high blood pressure and my life is very stressful. What are the signs to look for and what can I do to help myself?"

Answer:

Thanks, Jane, for the question. It’s an important topic and impacts people of all ages. As a neurosurgeon, I can tell you strokes don’t just strike older generations. Doctors today around the world are seeing people in the 30s, 40s and 50s having strokes. The reason? Mostly due to unhealthy lifestyles.

Jane you mentioned your life is very stressful and you have high blood pressure. These are two major risk factors of stroke. Other lifestyle factors that play a role include unhealthy diet, smoking,  lack of exercise and obesity. So any changes you can make in your life to increase physical activity, get your blood pressure in control will dramatically lower your risk. Studies show people with healthy blood pressure - less than 120/80 - have about half the lifetime risk of stroke as those with high blood pressure, or hypertension.

Knowing the early signs of a stroke is critical because immediate medical attention is needed to prevent long-term disability. What’s surprising is the majority of people ignore the early warning signs. In fact, a Mayo Clinic study found 58 percent of stroke patients brushed off the symptoms as another ailment, and delayed seeing a doctor for about 3 1/2 hours on average.

Time is critical because a stroke directly impacts your brain. There are two types, ischemic stroke and hemorrhagic stroke. An ischemic stroke is when the blood flow to a person’s brain is interrupted; hemorrhagic stroke occurs when the blood vessels actually burst in the brain.

Some strokes strike suddenly but more often than not your body will give you signals. Stroke patients often describe having the “worst headache of my life.” It comes on suddenly and can cause pain between your eyes, even a stiff neck. Suddenly feeling fatigued, dizzy and weak can be a signal. For example, you may be folding laundry or walking to a meeting and feel a strong, sudden loss of coordination. It’s also very common to feel numb on just one side of your body.

I can’t stress enough to tell your friends, neighbors, co-workers about these symptoms and don’t brush them off. If you are at high risk for a stroke and feel one of these symptoms suddenly occur, seek medical treatment as soon as possible.

And Jane, remember that strokes are preventable. I challenge you to get moving! Make a goal to exercise at least 30 minutes a day. It’s not only going to naturally reduce your stress levels, but will also help bring your blood pressure down and reduce your overall risk.