Dehydration occurs when you use or lose more fluids than you are taking into your body. This results in your body not being able to perform its usual functions that require proper fluid intake.  If you don’t replace these fluids, you become dehydrated.  We lose water and salt daily through vapor from breathing, sweat, urine, and stool.

Causes include poor fluid intake due to illness or mouth sores, or nausea, intense physical activity,

hot weather, severe diarrhea or vomiting, fever, sweating, poor fluid intake with increased activity and hot weather, and increased urination due to a medical condition such as diabetes or medications.


Mild to Moderate symptoms include dry, sticky mouth, thirst, decrease in urination, fatigue,

no wet diapers for at least 3 hours, few or no tears when crying, dry skin, headache, constipation, dizziness, and muscle cramps.

Severe symptoms are considered a medical emergency. If you experience great thirst, are irritable or confused, feel weak, have a very dry mouth, little or no urination or sweating, eyes look sunken in, a

low blood pressure, rapid heart, rapid breathing, tenting of skin, fever, fainting, and a swollen tongue, you need immediate medical attention.

Complications of dehydration include heat exhaustion or heat stroke, swelling of the brain, seizures, low blood volume shock (Hypovolemic Shock), kidney failure, coma and death.

Treatment for kids includes small frequent sips of rehydrating solutions, such as Pedialyte, popsicles, and water.  In adults, Gatorade, PowerAde, water, and ice chips are effective.  Additionally, wearing

loose clothes, air conditioning, fans, cool wet towels, spray bottle with water, avoid alcohol, caffeine.

You can also break up exposure to heat by spending 10-20 min in heat then going inside to get cool.

Milk, caffeinated drinks, fruit juices and gelatins don’t relieve dehydration and can worsen diarrhea.

Heat Exhaustion!

When it is hot outside your body cools itself by sweating. Your body cools as the sweat evaporates from your skin.  But if you are overexposed to heat or are doing strenuous physical activity your body loses its ability to cool itself properly.  This is called heat exhaustion. This can be caused by loss of water and electrolytes through sweating as a result of hot, sunny, humid weather, and physical exertion in that weather.  Elderly and children are at greater risk due their body’s inability to regulate body temperature, and lack of cool air. Drugs, such as, ecstasy, cocaine and amphetamines, can cause rapid rise in body temp.

Symptoms of heat exhaustion include, nausea, dizziness, irritability, headache, thirst, weakness, high body temperature, excessive sweating, decreased urine output, confusion, vomiting, muscle cramps, which is related to low blood sodium and potassium.

Heat exhaustion can occur in the elderly because they are less likely to drink enough fluids or sense significant changes in temperature. Heat exhaustion in kids can occur as babies and young kids are very sensitive to extreme heat.  Keep cool and hydrated. Don’t leave them in the car, even with the window open.

Treatment- When the temp is over 91 you need to take precautions

  1. Go to a cool area
  2. Remove layers of clothes
  3. Fanning and wet towels
  4. Dizzy may be related to low BP, so lay down and put your feet up
  5. Drink water or sport drink, and sip slowly
  6. If you have continuous vomiting get medical attention immediately

Heat exhaustion can progress to heat stroke, which is a medical emergency.

Heat Stroke (Sun Stroke) occurs when there is a high body temp of 103 or higher. It is considered hyperthermia without fever.  Symptoms include hot, red, dry or moist skin, rapid and strong pulse, and loss of consciousness.  Call 911, move person to cool area, cool person down with cool cloths or bath, DO NOT GIVE FLUIDS.

Those at risk for heat stroke are those wearing dark, heavy, padded clothes, and over dressing, has a high percentage of body fat, dehydration, Fever, beta blockers (cardiac medication), antipsychotic medication, alcohol and caffeine.

The most important thing to remember is to not wait until you are thirsty to drink fluids.

Managing your Sunburn!

Sunburn is radiation burn due to overexposure to Ultraviolet (UV) radiation mostly from the sun or sun tanning.  Too much exposure can be dangerous, but a lesser amount of exposure would lead to a tan.  Sunburns are considered a superficial burn.  Extreme burns can result in hospitalizations. Sunburns can occur in less than 15 min.  Some medications can create greater sensitivity to UV radiation, such as, antibiotics, birth control pills, and tranquilizers.

Suntan is a result of slight to moderate exposure that causes a release of melanin, a protective pigment that is the skin’s natural defense against overexposure.  Suntans are viewed as exotic and desirable.  Repeated extreme exposure over time can lead to damage to your DNA and skin tumors, dry wrinkled skin, dark spots, and freckles.

Those with the greatest risk for skin burns are those with fair skin, living or on vacation somewhere sunny or at a high altitude, work outdoors, and participate in outdoor recreation.

UV Index is the risk of getting sunburn at a specific location and time of day, such as:

  1. Time of Day 10 AM-4 PM- sun’s rays are at their strongest
  2. You can even get burn on cloudy days
  3. Reflective surfaces, such as, snow, ice, water, and concrete
  4. The position of the sun, which is greatest late spring and early summer
  5. The higher the altitude the greater the risk of a sunburn.
  6. Proximity to the equator- closer you are to the tropical regions of the planet 50% greater chance of getting sunburn.
  7. Incidence and severity of sunburns have increased worldwide because of damage to the ozone layer of the planet due to ozone depletion.Complications include skin cancers (Melanoma, basal-cell carcinoma, squamous cell carcinoma), and sunburn to the corneas of your eyes.
  8. Appearance of sunburns include red skin that feels hot is caused by the increase of blood to the area to heal the burn. Also there is pain, fatigue, dizziness, swelling, itching, and peeling skin, rash, nausea, fever, and chills. Fluid filled blisters that can burst and become infected. After exposure, skin may turn red from 30 min to 2-6 hours. Worst of the pain is 6-48 hours after exposure. The burn continues to progress for 1 to 3 days. Skin peeling can last about 3-8 days.

Prevention is the Key:  use hats/caps, clothes that cover arms and legs, and use wraparound sunglasses.

Moderate sun tanning without burning can prevent sunburn. A diet rich in vitamin C, and E can help reduce the amount o sunburn.  Beta-carotene (Vitamin A) helps protect against sunburn.  Protect your skin with sunscreen or sunblock.  The higher the SPF the less the DNA damage is to the skin.  Sunscreen helps prevent some forms of skin cancers. Apply 30 min before exposure and 30 min after exposure, and any time you get wet.

Treatment options include

  1. Pain medication- ibuprofen, naproxen
  2. Corticosteroids- for itching
  3. Cool the skin- cool compresses, cool shower
  4. Moisturizer- aloe vera, hydrocortisone cream
  5. Don’t break blisters- it is a protective layer, and breaking it will slow healing. If it breaks clean with soap and water and apply antibacterial cream and cover with a wet dressing.
  6. Drink plenty of water
  7. Avoid further sunlight
  8. Products that contain benzocaine can irritate the burn and cause allergic reaction.

What Type of Headache do You Have?

When you are looking at headaches, it is important to look at location, quality, severity, duration, and unique features of that headache. There are many types of headaches.  They are caused by cough, cranial nerve inflammation, infection, Injury, substance abuse, bone structure of the head or face, blood flow to and from the brain, changes in brain chemistry, tumors, and seizures.

Ice cream headaches cause brief, stabbing head pain when you eat, drink, or inhale something cold. “Brain Freeze” occurs when the blood vessels constrict (narrow) to prevent heat loss, and then dilate (open)to let blood flow rise.

There are 4 Main Types of Headache:

  1. Sinus– Sinus infections may erode through the bones of the sinus and structures in the face. The pain and tenderness is frontal, at the brow, and/or below or behind the eye. The sufferer may also experience bilateral pressure and fullness of cheeks, fever, fatigue, sore throat, cough, and decrease ability to smell.
  2. Cluster– is a stabbing or sharp pain, which may cause swelling around eyes or to eye lids. Cause is unknown
  3. Tension– This type of headache may be caused by fatigue, bad body posture, stress, and extreme exertion. The discomfort felt is bilateral head tightening. Complications include dependence on analgesics, and the risk of epilepsy is 4 times greater.
  4. Migraine– tends to start in childhood or adolescence. Women are 3 times more likely to get a migraine headache. Menstrual migraines are often treated by taking oral contraceptives. Researchers find there may be an imbalance of the brain chemical- serotonin. Complications include chronic migraines, seizures, migraine infarction (symptoms of stroke with blood loss to an area of the brain), medication over use (rebound headache), and abdominal complaints. Serotonin syndrome is when the body has too much serotonin due to taking migraine meds along with antidepressants called SSRI’s (Zoloft, Prozac, Paxil) or SNRI’s (Cymbalta, Effexor). There is a genetic predisposition to migraines. 80% of migraine sufferers have a family history.                                                                                                              Migraines have 4 phases:
  1. First- Pro-drome- up to 48 hours before the migraine. The sufferer may experience emotional changes, yawning, urinary frequency, fluid retention, stiff neck, and thirst or food cravings.
  2. Aura-warning, flashes of light or wavy vision, tingling on one side of face or body, speech disturbance.
  3. Headache- Throbbing, sensitive to light, noise, odors, movement, nausea, vomiting, blurred vision. Severe, debilitating head pain.
  4. Post-drome- after pain resolves, fatigue, irritability, euphoria that lasts a day or longer, and feels drained.
  1. Seek immediate medical attention:Sudden, severe headache that feels like a thunderclapHeadache after a head injuryNew headache after the age of 50.
  2. Persistent headache after straining, or exertion
  3. Headache with fever, seizure, confusion, difficulty speaking, double vision, numbness.
  4. THE WORST HEADACHE OF YOUR LIFE- This is a medical emergency and needs Emergency Room evaluation.
  5. Triggers- foods that contain tyramine-in aged foods like deli meat, aged cheeses, avocado, bananas, dried fruit. Foods that contain MSG. Also, chocolate, aspartame, beer, and wine. Environmental- stress, irregular sleep patterns, odors, weather changes, bright light. Women- notice migraine pattern with hormonal changes, and worsens at time of period, and improvement during pregnancy and menopause.
  6. Treatment works best when symptoms are treated early. Medication over-use headaches can occur when treatments for more than 3 days a week. Over use can worsen an underlying condition and decreases response to treatment. Prevention Treatments- for 1 or more headaches a week or for those with severe headaches that interfere with normal activities. Useful for 6 months and then begin to taper.
  7. Natural remedies to prevent headaches include Vitamin B2, Magnesium, Co-enzyme Q10, butterbur, and feverfew. First check with your doctor as there may be drug-drug interactions with other medicines.
  8. Diagnosis- Blood Tests and Spinal Tap to look for infection or toxins, CT Scan and MRI to look for tumors, infection, brain damage, and bleeding.
  9. Treatment:
  1. Pain- Relief
  1. Aspirin, Acetaminophen, Ibuprofen, Excedrin, indomethacin.  Use with caution as over use can cause liver and kidney damage.
  2. Triptans- block pain in the brain, constrict blood vessels. Pill, Nasal spray, injection. Imitrex, Maxalt, Axert, Amerge, Zomig, Frova,Treximet (Imitrex with Naproxen), and Relpax. Side effects: nausea, dizzy, drowsy, muscle weakness. Do not take if at risk of heart attack or strokes.
  3. Ergots- Ergotamine and Caffeine combination- can cause nausea and vomiting, Migranal- ergot derivative with less side effects than ergotamine, and people respond better to it. It comes in nasal spray and injection.
  4. Anti-nausea- helps to take with migraine medication
  5. Opioid meds- narcotics, but are habit forming.
  6. Glucocorticoids- prednisone or dexamethasone
  7. Pain- Prevention- reduces the frequency, severity, and length of migraine.
  8. Cardiac drugs- beta blockers- Inderal, Lopressor, betimol. ACE Inhibitors- lisinopril,  calcium channel blockers- calan
  9. Anti-depressants- amitriptyline, Effexor
  10. Anti-seizure- Topamax
  11. Botox- injected every 12 weeks.
  12. Alternative Medicine
  1. Acupuncture, biofeedback- how to control physical responses to stress, massage therapy, cognitive behavioral therapy- teaches you how behaviors and thoughts affect how you perceive pain.
  2. Herbs, Vitamins, Minerals
  3. Muscle relaxation exercises- meditation or yoga, Reduce Stress
  4. Get enough sleep
  5. Rest and relax- dark quiet, cool room
  6. Headache diary, don’t skip meals
  7. Preventive therapies-
  1. Transcutaneous supraorbital nerve stimulation (t-SNS)- FDA approved
  2. Learn coping strategies.
  3. Consistent daily schedule with sleep, meals, and medications
  4. Reduce intake of estrogen

11 Ways to Treat Bell’s Palsy

Bell’s palsy is defined as one sided facial paralysis due to an inflammation of the 7th cranial nerve of the face, that results in weakness or paralysis of the muscle on the affected side. The inflamed and swollen nerve becomes so compressed that it becomes damaged.

Bell’s palsy has a rapid onset, there is a slower recovery in elderly patients. There is complete recovery in majority of patients. Partial recovery can occur if contractures (tightening) occur on the affected side of the face. It may recur, but this is rare.

Up to 40,000 Americans a year get Bell’s Palsy. It can affects any age. The most susceptible are pregnant women, those who have diabetes, the flu, and a cold or other respiratory conditions.

The cause is unknown, but may be related to vascular ischemia [decreased oxygen to tissue causing damage to tissue], a virus (herpes, chicken pox, Flu, Measles, Mononucleosis), Lyme’s disease, tumors, a bacterial infection, or autoimmune disease that cause inflammation to the nervous systems (Multiple Sclerosis).

Characteristics include tearing of the affected eye, painful sensation to the face, pain behind the ear, pain in the eye, difficulty speaking and eating on the affected side, drooping eye, difficulty opening and closing eyelid on the affected side (can cause corneal ulceration due to drying of the eye), drooping of face and lips on the affected side, change in taste, sensitive to sound, drooling, and headaches.

Diagnosis is based on the characteristics mentioned, MRI or CT scans to rule out a tumor or other pressure to the facial nerve as the cause. An Electromyography, a test for nerve damage and to test for severity, can also be performed.

The goal of treatment is to maintain facial muscle tone and prevent further nerve damage. This is not a stroke and recovery can take 3 weeks to several months, and in a few up to a year.
1. Corticosteroid (prednisone) help to reduce inflammation and swelling, which then reduces compression to nerves and blood vessels. This helps to decrease severity of the paralysis, decrease pain, and prevent permanent nerve damage.
2. Remove the cause of the damage to the nerve, such has a tumor.
3. Oral care is important to prevent cavities.
4. Protect eyes from dryness with sunglasses and natural tears eye drops
or wear an eye patch at night.
5. Take pain medication such as Acetaminophen or NSAIDS (Ibuprofen, Aleve).
6. It is rare but surgery may be necessary to decompress the nerve
7. Gentle facial massages, and facial exercises to maintain muscle tone.
Physical therapy can help return muscle functioning.
8. Apply moist heat to relieve pain
9. Emotional support due to change in body image
10. Alternative therapy: L-lysine 500-1000 mg daily, and Vitamin B12 5000
once a day, help to heal nerve damage
11. Antivirals can be prescribed by your doctor.

Seek immediate medical attention if you ever have paralysis to rule out stroke.

4 Types of Travel Notices that Can Save Your Life!

The CDC provides travel health notices for travelers regarding possible health issues at their destination site. Health issues at any destination can be created by severe weather (floods, hurricanes, etc.), no power resources available, no potable (drinkable) water, insect or animals, outbreaks of diseases or wars.  The CDC provides a travelers health page, as well as the US Department of State on their Travel Alerts and Warnings page.  For weather conditions, visit the NOAA International Weather Selector page.

4 Types of Notices

Watch A (Level 1) notice encourages travelers to practice usual precautions, such as, vaccinations, hand washing, and avoiding mosquitoes.

Alert (Level 2) notices encourage travelers to practice enhanced precautions, such as, additional vaccinations, and monitoring for local disease outbreaks.

Warning (Level 3) notices encourage travelers to avoid non-essential travel because they are at risk for exposure, such as, a large scale outbreak, war.

Avoid (Level 4) notices instruct travelers to avoid all travel due to dangerous situations that can put their life at risk.

Safety Considerations

Animal safety, such as, exposure to bites, scratches, saliva, and fecal/urine from cats, dogs, bats, rats, and insects, can result in long term or permanent illness or death. Rabies is still a very common infection around the world.  Insect bites from fleas, flies, mosquitoes, ticks, and bed bugs can cause a host of infections from mild to serious.

Hypothermia and frostbite can be acquired from destinations with cold weather.

Sun or heat exposure from hot weather destinations and UV rays can cause sunburns, and heat stroke.

High altitudes can cause altitude sickness which can then result in flu like symptoms, carbon monoxide poisoning, pulmonary and cerebral edema. High altitudes have a low pressure of oxygen that affects humans more than animals.

Natural disasters can cause injury by blunt trauma, drowning, and crush related deaths.

Food and water safety is crucial to the traveler. Fresh cold pasteurized milk, alcohol, and steaming hot drinks and food should be safe.  Heat kills germs.  Bottled and canned water and drinks are safe if the traveler opens them.  Buffets can lose heat and get contaminated.  Dry or packaged foods are usually safe as long as it is not handled by others.  Avoid raw food, street food, and bush meat as Ebola and SARS can be spread to the traveler. Tap water is risky for drinking, showering, and brushing teeth. Fountain drinks and ice are also risky.  Fresh juice is safe if washed in safe water and squeezed by you.

Acute vs Chronic Bronchitis

Acute bronchitis is more common during cold and flu season. Acute inflammation is caused by a virus or bacterial infection and usually resolves on its own except for people with:
1. Respiratory irritants such as cigarette smoke, pollutants, chemicals
2. Lowered immune system- such as children, elderly, pregnancy, cancer,
diabetes, HIV
3. Heartburn- GERD
4. Respiratory conditions- Asthma, Chronic Obstructive Pulmonary Disease
Symptoms usually began with upper respiratory set the symptoms such as sore throat stuffy nose and cough. The cough starts as a dry hacking nonproductive and usually interrupts sleep. After a few days mucus production begins. Chest X rays may be normal or show inflammation. Scattered wheezing may be noted, and fever may be present. Respiratory infections can last up to 3 weeks. Symptoms include cough with little to no sputum, low grade fever or chills, sore throat, body aches, tightness or pressure of the chest. Sputum tests look for type of respiratory infection such as pertussis.

Chronic bronchitis involves excessive mucus production. There is a relationship between the amount and duration of cigarette smoking and severity of bronchitis. But in advanced stages of chronic bronchitis, emphysema can develop as well as heart failure, increased airway obstruction, and Polycythemia which can result in pulmonary embolism. Diagnosis occurs when the cough and increased mucus production occurs three months each year for two years. Advanced stages of chronic bronchitis can resemble emphysema. Over time chest xray results would show hyperinflation of the lungs. Pulmonary function tests show airway obstruction.

Seek medical care if:
1. Cough lasts more than 3 weeks
2. Prevents you from sleeping
3. Fever of more than 100.4
4. Yellow/green/dark colored mucus or having streaks of blood
5. Having wheezing or SOB

Treatment includes bed rest, and increase of fluid intake as well as:
1. An antibiotic if infection is bacterial
2. Cough medicine- to help expectorate mucus. Cough suppressant only at
bedtime allows for better sleep
3. Inhalers to reduce inflammation and open narrowed passages in your lungs
4. Wear mask if your exposed to respiratory irritants at work
5. Use humidifier
6. Vaccines- flu, and pneumonia
7. Hand washing to prevent spread of viral infections.
8. Use hand sanitizers


Heartburn, or acid indigestion, is a burning sensation mid chest that worsens when you bend over or lay day. It usually occurs after eating and at night.  It is caused by reflux. Reflux occurs when the acid in your stomach backs up into your food pipe (esophagus), resulting in inflammation.  It is considered a disease when you have symptoms more than 2 times a week.

Gastroesophageal Reflux Disease (GERD) is a condition of digestion that allows stomach acid to go up the esophagus due to a weakening of the muscle at the point where the esophagus ends and your stomach begins. GERD often interferes with routine daily activities, and result in damage to your esophagus.

Symptoms- heartburn, vomiting or spitting up blood, bitter taste in mouth, burning chest pain, dry cough, painful throat, painful swallowing, and hoarse voice.

Complications- scarring of esophagus, bleeding in stomach or esophagus, ulcer formation in esophagus or stomach

Risk Factors

Spicy or hot foods

Alcohol, soda, caffeine

Fatty foods

Gassy foods (certain vegetables)




Abdominal hernias

Treatment for GERD

Antacids– help to neutralize the acids in your stomach, but will not treat the inflammation of the esophagus. Over use can cause constipation and diarrhea.






Histamine-2 (H2) Blockers -Reduce production of acid in stomach. May not be as good for treating esophagitis (inflammation that occurs in the esophagus). Histamine stimulates acid production, especially after meals, so H2 blockers are best taken 30 minutes before meals. They can also be taken at bedtime to suppress nighttime production of acid. Examples of prescription H2 blockers:

Nizatidine (Axid)

Famotidine (Pepcid)

Cimetidine (Tagamet)

Ranitidine (Zantac)


These drugs are useful at relieving heartburn, but may not be as good for treating esophagitis (inflammation that occurs in the esophagus).

Side effects can include headache, abdominal pain, diarrhea, nausea, gas, sore throat, runny nose, and dizziness.

Proton Pump Inhibitors (PPIs)

Drugs that block acid production more effectively and for a longer period of time than the H2 blockers, PPIs are best taken an hour before meals. They include:

  • Rabeprazole (Aciphex)
  • Esomeprazole (Nexium)
  • Lansoprazole (Prevacid)
  • Omeprazole (Prilosec, Zegerid)
  • Pantoprazole (Protonix)
  • Dexlansoprazole (Dexilant)

Many doctors do not believe that one drug is more effective than the others in treating GERD. These medications are also good for protecting the esophagus from acid so that esophageal inflammation can heal.

Side effects can include headache, diarrhea, abdominal pain, bloating, constipation, nausea, and gas.

Home Care

Avoid eating foods and drinks that trigger heartburn. fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, citrus fruits (Pineapple, strawberries), vinegar, foods that can cause gas (peppers, cabbage,) and caffeine may make heartburn worse.

Do not over eat.  Try eating smaller frequent meals.

Do not lie down after a meal, and wait 2- three hours after eating before lying  down or bending over

Elevate the head of your bed

Do not smoke.

Avoid medications that can irritate your stomach, like NSAID’s (Aspirin, Aleve, Ibuprofen)

Weight loss may help to reduce abdominal pressure pushing acid into the esophagus

Avoid wearing tight clothes

Seek medical attention if symptoms occur for more than 2 times a week, and over the counter medications do not help, if you have difficulty swallowing, nausea, vomiting, or weight loss.

6 Key Symptoms of Asthma

The Mayo Clinic defines Asthma as “…a condition in which your airways narrow and swell and produce extra mucus. This can make breathing difficult…” The Environmental Protection Agency (EPA) reports there are 24 million people with Asthma, 6 million of which are children. Over 14 million doctor office visits were related to asthma, and 1.8 million emergency department visits.

6 Symptoms Key to Asthma

1. Wheezing
2. Cough
3. Frequent episodes with difficulty breathing or shortness of
breath, with or without wheezing.
4. Frequent episodes of chest tightness.
5. Symptoms worsen when exposed to respiratory irritants, such as
cigarette smoke, pollen, animal fur, exercise, etc.
6. Symptoms worsen at night.

Asthma is a controllable condition through an action plan. According to the National Heart, Lung, and Blood Institute, and the National Asthma Control Initiative the goal of therapy is control by prevention of asthmatic episodes. An action plan allows asthmatics to be healthy, and active, and involves:

a. Following your treatment plan prepared by your medical doctor.
b. Managing environmental triggers.

Knowledge is power!
It is important to be aware anxiety does not cause asthma. Asthma is caused by an inflammation. Asthmatic medications do not cause addiction. Asthmatic medications do not lose their effectiveness over time. Never delay starting treatment to see if the asthma will improve by itself. Always check you have enough medication left in the inhalers, as well as for expired dates. Corticosteroids are safe, and are not the same as anabolic steroids. Watch for asthma triggers such as respiratory irritants (pollutants, second hand smoke, flu, etc.) that can worsen symptoms. Rinse mouth after using inhaled medication. No eating peanut butter.
Daily control is demonstrated by good breathing, no cough or wheeze, being able to have a good night sleep, and the ability to play and exercise. If you have cough, mild wheezing, chest tightness, especially at night use your quick relief medication. If your symptoms are not controlled within 20 minutes or after 2 efforts of quick relief, call your doctor or go to urgent or emergency care. If quick relief medication is required more than 2 times a week, then call your doctor. Do not wait to get emergency help if you are breathing hard and fast, your nose is flaring, your ribs are moving deeply in and out, you have difficulty walking and talking, you have blue lips, fingernails or earlobes. Get the flu vaccine every year.