Friday, October 30, 2009

The flu

I once heard from a patient, "You know you have the flu when your hair hurts." Well my hair hurts today, not because I have the flu but it certainly seems as if everyone else does.

I received my flu shot for the common seasonal flu over a month ago. Now city officials say all the current flu circulating is the swine variety. This is a problem since there is no vaccine. The hospital asked for 7,000 doses. They received less than 700. Pregnant employees in the emergency room and women's and children's services were the first to be vaccinated. Other pregnant employees will be next.

Flu is a dangerous disease in pregnancy. It can lead to pneumonia and hypoxia, a fancy word for too little oxygen. As you can imagine, too little oxygen is not good for mother or baby. We have had several mothers and mothers to be in the intensive care unit. So far we have not had a maternal death but we have come very close - twice.

I try not to think about getting the flu and I must admit, I am more afraid for my sons than for myself. The young seem to be very vulnerable to this virus. One patient who was in the ICU for two weeks is the same age as my oldest. He is not pregnant but he has an underlying medical condition. I will not hestitate to give him an antiviral should he or anyone in our household comes down with the swine flu.
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Anonymous said...

What do you think about the current policy of not testing to see if patients have H1N1? I think that my son had it, he as exposed, then developed symptoms and I promptly put him on Tamiflu, he was sick for several days but not alarmingly sick. Now I do not know if he has had it or not and in a dormitory setting, I am going to get the vaccine for him if I can find it. If I knew for sure that he had it, then there would be no need for the vaccine and someone else who has not had H1N1 could get the vaccine. Would it not make more sense to test everyone with a suspected case, so that the few vaccines available can be given to people who have not already had it?

local MD said...

In the hospital where I practice, when we first began seeing cases, the lab was set up to do the rapid test only and the PCR had to be sent out, requiring 48 hours. We had several negative rapid tests where the PCR then came back positive. One patient was in the ICU before her PCR came back positive. Since that time (2 months) we have been treating everyone with a negative test and stopping treatment if the PCR is negative. We now have a shorter turn around (4 to 12 hours depending on the time of day). My experience with the rapid test is a high false negative rate exists.

So, I say all this to say, those who are at high risk (I deal primarily with pregnant patients but people with asthma and diabetes, anyone who has to take steriods or is immunosuppressed)should be treated. Again, in the population I serve, a number of patients have no insurance and frequently either no phone number or they do not give a correct phone number so they are more difficult to find for collections.

I would guess the ER sees several hundred people a day with flu symptoms. Just seeing them is a problem. I hope this helps you understand how protocols are set up, especially with large numbers such as college students. And YES, I would also vaccinate him if you can get the vaccine.

Anonymous said...

I understand not testing in an ER setting, but what about in the pediatrician's office where the parents, kids and doctors have an ongoing relationship of years and they know that they can call and give them the results? And where the parents are willing to pay for the test? It seems to me, that we could lessen the need for the vaccine by testing these kids.
I will be vaccinating my kids when I can get it, but wish that I knew if they had already had it, so that I could free up two vaccines for other kids who may not have been exposed yet.
Thanks for answering!