Thursday, May 28, 2009

Common Cold

I have spent the last few days fighting with what is probably a rhinovirus. Common cold. Frankly, I needed some rest, but sheesh, what misery. I have become a leaky incubus of viral plague. It is hard to stay positive when you are drowning in your own fluids.

In the meantime, here is a tool for differentiating between regular flu and swine flu:

Tuesday, May 19, 2009

Swine Flu Death -- Underlying Medical Conditions?

Check out this video. It is an interview Larry King did with the husband of one of the first people to die of swine flu in the US. This is not the first media report I have seen about this woman. Aside from the lawsuit issue, what is key here is the issue of "underlying medical conditions." Most media reports I have seen used this turn of phrase -- She died because of an "underlying medical condition." So what are we supposed to take from that? Oh, well, she would have died anyway? We don't have to worry about ourselves, because obviously she was at risk because of an "underlying medical condition"?

Here's her "underlying medical condition." She was pregnant. An emergency Cesarean section was performed in order to save her baby.

Monday, May 18, 2009

Lyme Disease

There's a very sad story on MSNBC about a woman with Lyme disease. In the late stages of the disease, she finally killed herself to get away from its misery.

From a medical standpoint, one of the problems with Lyme is the difficulty of diagnosis. The positive cases that are reported to me (Lyme is a reportable condition) generally place onset at a year or more ago. Sometimes many years ago. Unfortunately, they have missed the window of opportunity in which treatment is most effective. For many patients, the diagnosis was not considered until late in the illness. I had a doc tell me recently that we don't have Lyme disease in this part of the country. Well, A) that's not true, and even if it were, B) people do travel outside of this area.

When doing a case history, I have found that most people with Lyme disease do not remember ever having a tick attachment. Some do. Some clearly had the bull's eye rash. But a lot of them didn't.

Sometimes laboratories will report positive results which the physician will contest. It's a false positive, the doc will say, even though all the markers are there. Certainly that is a possibility, but these scare me, because the patient will not receive treatment.

It is important to review your lab work with your doctor. Ask to see it, and ask what it means. Laboratories flag values that are out of normal so the doctor can easily see it. If you see a flag, ask about it. If your doctor says it is a false positive, ask why she or he thinks that, and ask to be retested.

Friday, May 15, 2009

Swine Flu and Sick Time

CDC backed off school closures and everyone decided swine flu (or novel H1N1, whatever) was not any big deal. Here’s a problem with that. A little kid was reported to me with a positive rapid influenza A screen. A specimen was forwarded to the reference lab for further testing. I talked to the kid’s mom. She was concerned because she had just started feeling bad – and she is a pulmonologist. Who spends more of her time in a hospital intensive care unit. I told her per the CDC guidelines to stay home for 7 days, longer if she is still sick. She had me speak with the hospital administrator about this – yes, she really should stay out of your ICU, I said. The investigation was done, entered into our database, and filed.

Today we received confirmation that the child did have swine flu. I called the mom to let her know. Mom is still sick – she’s been running a temp of 102 for days and days. Oh, and she’s been working too. Instead of staying out of work at least 7 days, she stayed out 2. Her reasoning was that she does not get sick time and she was off unpaid. Then she tells me that one of her patients – with lung cancer – spiked a fever. Could he have swine flu? Hmmmm. YES DOC HE COULD. Why don’t ya go ahead and do a flu screen, then send a swab in for further testing? Please. Sheesh.

How utterly irresponsible. I informed the hospital infection control practitioner so he could follow up on exposed patients. He was not pleased (to put things mildly).

Having an infectious disease is a nuisance. It is an inconvenience. But please, let’s all take some personal responsibility. If you are infectious, you should not be around other people. And if you are an employer, be humane to your employees and provide sick time.

Monday, May 11, 2009


The blog has been down for a few days. It unexpectedly received a lot of media attention. That should be a blogger's dream, but I feared I might experience work-site related repercussions. Thank you kindly to those who wished to do interviews with me, but I am unable to do that at this time. Thank you for your understanding.

Back peddling?

CDC's back peddling on school closures sent a message to the public: "We over-reacted. So sorry. Nothing to see here folks, move along." But the crazy thing is, the virologist and epidemiologists don't seem to be in agreement.

Data coming out of Mexico on fatalities is showing people in their 30s with the highest case fatality rate. That is disturbing. In Norway, they grew a new variant of the H1N1 swine flu. The southern hemisphere goes into regular flu season soon, which means co-circulating viruses. And no one has said what will happen with H1N1 swine flu hits areas like Egypt who are reporting new cases of Avian influenza (human and bird) almost daily.

I don't mean to be Chicken Little here, but come on people. Let's not count our eggs before they've hatched. It will take time -- like it or not -- to truly understand how this thing will unfold. For now, in the US, it is mild. Thank goodness for that. But I think it is a mistake to totally let our guard down. There is too much evidence in the scientific community to support that.

This is a marathon, not a sprint. Now go wash your hands.

Friday, May 1, 2009

The Swine Flu Continues

A public health disaster is not like a tornado or a hurricane. They don’t just hit and leave you with a bunch of debris to clean up. They are insidious. Sneaky bastards.

This is my analogy of where we are today. I am standing on the beach, with scores of other public health workers standing along side of me. In the distance, off in the ocean, we see a hurricane. At least, we think we see a hurricane. It is hazy, and we are not 100% sure about what we are seeing. Nonetheless, we are all blowing as hard as we can, hoping to turn the hurricane back out into the ocean, where is will fizzle into nothingness.

More schools have closed. It is a tremendous burden on those who make that decision.

Many schools have cancelled extracurricular events for the time being. Several mothers left messages on my phone yesterday demanding to know why I would cancel prom and who was going to compensate them for the $800 they spent on their daughter’s dress.

First off, I didn’t cancel prom. I recommended people consider cancelling large gatherings. The school did not cancel prom. They rescheduled it. Second off, I would rather have your daughter not go to prom and be alive than go to prom and be dead in a week. Is it that dire? I don’t know, but I am not going to take that risk with your child.

It is so hard to work so many hours and then be criticized at every turn for over-reacting. Maybe we are. Honestly, I hope we are. I would love nothing more than for this to turn out to be nothing.

Remember Katrina? Remember how everyone criticized the government for not doing enough? Remember all the complaints, the fears, the people dying on the roofs of their houses? We learned a few lessons from that. One was don’t hesitate.

Friends of mine worked 50 hours straight on the ground in New Orleans. Their thanks was a big slap in the face for not doing enough.

Please know that the underlying philosophy, the guiding principal here is that WE DON’T WANT YOU TO DIE. That is why we do what we do.