Assembly-Line Medicine

This week’s guest columnists are Drs. Ashanti Smith and Ravi Alagugurusamy, Family Practice residents at the University Hospital and Clinics here in Lafayette.

It’s a common scenario now in Lafayette, and nationwide: The child wakes up feeling awful- tired, whining, feverish.  Her throat hurts, and she shivers from chills.  She’s also been coughing.  Mom gives her some ibuprofen, a glass of juice and…she goes back to sleep?  That’s really weird in this normally rambunctious kid, so mom brings her to the doctor.

The waiting room is packed with snotting, sneezing, hacking tots and their bleary-eyed parents. To add variety, one kid throws up.  After hours of waiting, they get a room, the doctor zips in, and proclaims the Influenza swab was positive.  He rattles off an obviously oft-repeated lecture on Influenza, what it is, how to treat it, and how long she’ll be sick.  A long time.  He dashes off to the next goopy patient.  Mom’s handed a prescription, a school excuse, and a paper describing Influenza.

Welcome to assembly-line medicine during flu season!  Doctors and nurses have to crank patients through as efficiently as possible- there’s so many to see!  Let’s unpack what happened above.  First, what is “Influenza?”  It’s the “flu” that you get a flu shot for, and have been hearing a lot about from friends, schools, and the news.  It’s a highly contagious virus that ravages the country every year between October and April- and this year’s been particularly active.

Highly contagious means that you catch it easily, and it’s easily spread to others.  One awful fact: if a kid with the flu coughs in a room, the tiny virus-laden droplets he expels will land on surfaces and remain infectious for 2 hours.  Thus if you touch a table or arm of a chair with the virus within that time, then lick your finger to turn a page, you’ll get it.

This is why the CDC recommends everyone get the flu vaccine every year.  You could inadvertently get it anywhere- school, work, the grocery store.  Okay, so it’s super-contagious.  So what? Isn’t it just some cough and congestion, maybe some fever, and lasts just a few days?

If you’ve ever had Influenza (the “flu”), you now get the vaccine every year, realizing it’s not just a bad cold.  Besides a hacking cough and pouring nose, you have the worst fever of your life- shivering under blankets and quilts despite ibuprofen.  Your head really hurts.  Your throat feels like you’ve swallowed glass shards.  Everything aches.  You have cramps and diarrhea, maybe vomit too.  You wonder- am I dying?

Even worse, it’s been three days with this misery.  At the doctor, more bad news- it can last 7 days before abating!  This is when you make deals with yourself and God.  I’ll never take feeling good for granted again!  I’ll get the flu shot next year!  Make it stop, I promise I’ll be good!

Our hurried doctor from above, running from room to room, stamps out prescriptions and school excuses left and right.  Got to keep the assembly line going- there’s so many miserables to see.  What’s he giving out?  Tamiflu.  Influenza is one of the few viruses for which there’s a medicine that makes it better.

However, it’s not a miracle drug.  Your kid’s not going to pop out of bed next day turning handsprings.  It shortens the course a little- a day or two.  It makes you a little less sick, and also importantly, a little less contagious to those around you.  But you’ve got to start Tamiflu within 48 hours of symptom onset, or it won’t help.

You wonder when you have the flu, am I dying?  Unfortunately, sometimes the flu does kill.  It’s particularly worrisome for the elderly, the pregnant, and the sickly.  Children who are already medically vulnerable- asthmatics, ex-preemies, special-needs kids, kids with heart conditions, are at high risk.  This is a big reason doctors, the CDC, and state health departments insist people get vaccinated.  With the vaccine and hand-hygiene, deaths are preventable!

So get your kid their flu vaccine now- it’s not too late.  Make sure they wash their hands.  And for goodness’s sake, if they have a fever, keep them out of school and get them seen at their doctor’s.  For their sake, and yours!  

Welcome To Flu Season?

This week’s guest columnist is Dr. Yamuna Jaladanki, a Family Practice resident at the University Hospital and Clinics here in Lafayette.  

The other day in the ER I saw two kids from the same family, one 11 months old and the other 9 years old.  Mother told me that one had fever, the other fatigue.  Mom also mentioned that one of her other children was tested positive for the flu.  Since both children were exposed to their sibling, we tested them for flu too.  Both were positive.  The whole family was in for a week of misery.

It’s that time of year when lots of parents bring their kids to Emergency Departments or Urgent Care Centers with complaints of fever.  Most of the time of the child has common cold or another 2 to 3 day virus.  But sometimes it is the flu.  You and many parents may wonder- what exactly is the flu?  Why is it in the news so much?  Why are we being constantly bothered to get the flu vaccine?

What is the flu?  People use the word “flu” for many illnesses.  Some say “stomach flu” when they mean a vomiting and diarrhea virus.  Some use “flu” to describe a cough/runny nose/fever virus.  But we in medicine use “flu” as a short word for Influenza, a particularly nasty virus with some special properties.

Influenza is a virus that gives its victim fever, and feelings of feverishness and chills.  Kids with flu often have cough, sore throat, runny or stuffy nose, and feeling tired.  Some kids may have vomiting, diarrhea, headaches, body aches, and blood-shot eyes.

Why is flu so important?  Most of the time kids who have flu have mild illness.  Some children are more prone to develop serious complications, like pneumonia, which can sometimes even be fatal.  These are children with asthma, heart problems, or neurological conditions.  For this reason, any child older than six months and people living around children should be vaccinated.

Why do we all need the vaccine?  Is it that contagious?  Yes, flu is highly contagious, meaning it is easily and quickly spread from person to person. Droplets of cough, sneeze, or even from talking can spread the flu virus from one child or adult to another.  Also touching a surface or object that has flu virus on it and then touching one’s own mouth, eyes, or nose can transmit the virus.  Another bad thing about contagiousness is that a person infected can spread the flu one day before symptoms develop.  This means an infected person can be passing the virus around even before he or she knows they have it!

What is the normal course of Influenza?  This is another nasty thing about the flu- the misery can last a long time, from 5 days to 2 weeks.  Most recover in one to two weeks.

What are the serious complications of the flu?  Influenza can lead to some bad complications, particularly in vulnerable kids like those with asthma.  These complications include bacterial pneumonia (serious infection of the lung), ear infections, sinus infections, dehydration, and worsening of asthma or heart problems or diabetes.

How do you test for flu and treat it?  We test for the flu by swabbing for mucus from the child’s nose.  If the kid tests positive, this is one of the few viruses that there are medicines to help, like Tamiflu or Relenza.  They can make the symptoms go away sooner and make the patient less contagious.  But the treatment must be started within 48 hours of the onset of symptoms to help- after that, the medicine won’t help.

Another important treatment is fluids.  Kids can become dehydrated from fever and from feeling so bad that they just don’t want to drink.  Some kids also vomit and have diarrhea with the flu.  Ibuprofen and Tylenol can help your child feel better enough to drink.  Also, your doctor can prescribe medicine for the nausea and vomiting.

So get you and your kids their influenza vaccine.  Get vaccinated each season, since the virus changes a little each year and new vaccine is needed to keep up.  You can not catch Influenza from the vaccine, but you really can catch it easily from the rest of the world. Welcome to Flu Season!