Should I protect myself from bird flu?

Q. With dire warnings of an avian flu pandemic, and the first UK government supplies of anti-viral drugs being reserved for certain groups of people, is it time for individuals to take responsibility for their own safety and stock up online with recommended treatments such as Tamiflu?

A. Avian flu is a specific strain of influenza A - the same influenza virus that causes human flu. About two years ago there was an outbreak of avian flu in South-east Asia, and the first cases of humans developing avian flu were reported. To date, 112 humans have developed avian flu, mostly in Vietnam, and 57 of them have died from it. More than 100 million poultry have died as a result of this outbreak, some from the disease and some from a cull that was carried out to contain the outbreak. The humans who caught avian flu were mostly people who had contact with poultry, and it appears that they all caught the flu from birds, and not from other human beings. The worry is that the virus may transform itself so that it is capable of spreading from human to human. If this happens, humans will have little natural resistance to the disease and it could spread quickly, with deadly effect. Tamiflu is a drug that may be effective in treating avian flu in humans. No one knows how effective it will be, and there are also fears that the virus will become resistant to Tamiflu - it has already become resistant to two other anti-virus drugs. A quick internet search shows that Tamiflu does seem to be available online, following a quick "consultation" with an overseas online doctor. It's not cheap - 10 tablets (the recommended treatment) cost $110 (about £6 per tablet). I'm not intending to buy any, but I tend to be a naturally optimistic person. If you think it's a good idea, I wish you luck.

UNSIGHTLY SCAR

Q. I have developed a keloid scar at the site of a gallbladder operation. The operation was a great success and got rid of my gallstones, but I have been left with a huge red scar under my right rib cage. The surgeon has suggested leaving if for a year before deciding on any further treatment, in the hope that it will fade and become less unsightly. Is there any quicker way to get rid of it? What causes keloid scars?

A. A keloid is caused by overgrowth of fibrous tissue at the site of a skin injury. As the skin begins to heal following a cut - either accidental or surgical - it usually knits together flatly. But occasionally the scar seems to overgrow and spread into the surrounding tissues. When this happens, it is called a keloid. If you look at the keloid scar tissue under a microscope, it contains thick bundles of collagen, a material that occurs naturally in normal skin. Certain racial groups are more susceptible to keloids. About 1 in 6 people of African origin claim to have keloids. They are much less common in white people. Keloids can result from relatively minor skin injuries - even ear-lobe piercing can provoke keloid formation. Your surgeon has suggested waiting a year because some scars that seem to be forming keloids end up flattening themselves. True keloids, however, never disappear without some sort of treatment. There is a huge range of treatments available, but none of them is guaranteed to work. Steroid injections into the scar, laser treatment and even radiotherapy and chemotherapy have been used. An operation to remove the keloid scar usually just results in a new one forming, sometimes worse than the original keloid. Seek the advice of a dermatologist or plastic surgeon, and don't rush into anything.

Have your say: Readers write

JY's two children have alpha-1 antitrypsin deficiency:

Through King's College Hospital in London, we were referred to the Children's Liver Disease Foundation, who provided us with all the information we needed, as well as invaluable support. Their website, www.childliverdisease.org, provides everything parents need.

A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS; fax 020-7005 2182; e-mail health@independent.co.uk. Dr Kavalier cannot respond personally.

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