Saturday, October 24, 2009


I got my arm injected with the new stuff this week. We received about 200 doses and between our staff and our pregnant patients we just about used it up. No, I didn't get the shot in the butt, and it didn't hurt any more than the seasonal flu shot (which it shouldn't, since it's made in the same way and given in the same way). But I'm on call this weekend, and the phone never stops ringing for long. Taking calls from worried parents with sick kids doesn't bother me much; that is why I get paid the medium bucks. What troubles me is that this bug seems to be changing the rules that we've worked so hard to adhere to, and that our patients have come to accept, that is, the rules about confirming a diagnosis to some extent before throwing medicine at it, and being conservative about using that medicine, to avoid teaching the bugs how to resist it.

The CDC wants us to strongly consider prescribing Tamiflu or Relenza to patients "at increased risk of complications" without examining them if they have fever and respiratory symptoms. That risk group includes all pregnant women, children before age 2, and people with common chronic health problems (think asthma, diabetes, heart disease) that make suffering through the flu more dangerous. I am prescribing according to those recommendations, because I think it'll save lives this year, but wonder what this practice will do to the long-term usefulness of the very few anti-virals that work for flu. Already Tamiflu no longer works on seasonal ("regular") flu. But we weigh this against the slow output of vaccine, and the value of keeping sick people out of waiting rooms and emergency departments, which are full of people who shouldn't be exposed to coughing/sneezing flu victims, and the danger of this illness to some young people, and this is where we are, treating people with a phone call.

For the record, I've been exposed to lots of this crud, and I'm fine, as are all my fellow providers. I think this is one wonderful case where being old is a good thing. (If any of you reading this can think of other such cases, I'm always looking for things to be thankful for.) Also, if you are one of the many who thinks animation and viruses are a natural match, check out and scroll down to "Flu Attack! How a Virus Invades Your Body". It is creepy but cool.

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