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Wednesday, November 18, 2009

Swine Flu Thoughts

I'm weighing in a little late on this topic. Since there is so much hysteria over swine flu, I thought I'd share my experience.

My background is urgent care before going into private practice and for the most part I leave time in my schedule for same day "sick" add-ons. In other words, you would think I am on the front line for treating the flu. According to the media, you would think I would be inundated with swine flu cases. In reality, I have not seen what I can call swine flu. (Is it just my practice?) The only exception is a 6 year old boy with chills and fever last spring (at the beginning of this "epidemic") who was very sick. His flu (regular flu) test was positive. Since it was out of season, we CONCLUDE it was swine flu.

I have seen enough colds, strep, bronchitis. If I have seen swine flu in the office, it's been mild and not something to cause as much hysteria as the media would lead you to believe. Some people have asked for Tamiflu, the antiviral. I am fine prescribing it as long as the patient realizes, I can't confirm the swine flu. I don't mind providing coverage if there is doubt in exposure history.

John said at his hospital there has been a few cases of confirmed swine flu. One case he recalled for me, the patient had underlying problem -- weighing 400 pounds.

At one point John thought he had swine flu. I didn't agree. He tends to think he gets everything that goes around. He wanted to take Tamiflu and wanted one of our boys to take a few doses.

I don't have confirmation test for swine flu. Most small practices can't confirm, so I don't know where all the documented confirmed cases are coming from. Small offices can preform a nasal swab for flu and if it's out of season for flu call it the swine flu.

I can't remember when exactly the swine flu became well known as H1N1. H1N1 sounds so much more clinical. It puts another spin on it. Perhaps when the vaccination was being developed?

Most of you already know my office is not giving H1N1 vaccination. John's practice for the most part is over the age at risk. My younger practice doesn't really demand vaccinations. I thought the few who really wanted it had other opportunities to get it at the Health Dept, Walgreen's, or through employer, at their own discretion. It's an expensive vaccination for a private practice to invest in. Since I feel the vast majority of my clientele did not want it or do not need it, we passed on the opportunity to provide H1N1. I'd rather provide Tamiflu early on if flu like symptoms present for those that want something.

Like everything else I do try to provide individualized care. Perhaps a person travelling to colder climates may have other considerations? I've talked to several pregnant women and have given them "permission" to resist pressure to take H1N1. I suppose the thing that bothers me the most is how fast it was developed and came out. I have written one script to be picked up at a pharmacy for it for a biologist who wanted to analyze it in a lab. Me and my kids did not get the shot. I don't think John took it, but he mentioned the ID nurses had his ready for him.

There is so much media coverage and fear surrounding this. Most of my patients are relieved to hear I am not caught up in it.


myers580 said...

a lady i worked with got the swine flu and she said it was not a big deal. she said it was just like having the regular flu and she missed 2 days of work. I really think that this swine flu was created in a lab to make americans spend money...h1n1 came about because the pig farmers freaked out when the cdc released the name as swine.....they said that the label would deter meat eaters from buying pork so they renamed it to h1n1.....the author of Eating Animals said that in one of his interviews.

Permission to Mother said...

I appreciate the info. I don't eat pork and wouldn't have ever thought to see it that way.

Elizabeth said...

I have read the number of reported deaths to be significantly lower than those with the regular flu. Why the hysteria? Maybe to sell vaccine? Our family had the flu this year. Everyone recovered within three days. Including the youngest.

Christy said...

I've never had a flu shot, hubby gets one every year. So we were on different sides of the fence when it came to giving it to our 2yo son.

After spending lots of time doing online research, and talking to you, I felt comfy not giving the regular or h1n1 it to our son. I don't feel it was tested enough to give it to him. Also swaying my decision is I have Guillan Barre, which they say started with the 1976 swine flu vaccine. Scary.

My dad on the other hand is VERY mad at me for my son not getting it. Luckily my brother hasn't given any vac to his 1yo daughter, so I pushed my dad off on my brother. Arguement averted short term! :)

Bandora said...

I opted out of yearly flu shots years ago and when the hype over swine flu started I never considered the option of getting it. Now that I am pregnant, the pressure to get the vaccine from the "mainstream" medical community is intense but the little research that I've done on the vaccine is beyond scary. I actually had a nightmare about a nurse giving me the vaccine without my consent just because I'm "high risk".
I just see it as another reason to stick to a midwife and have a homebirth.

crispy said...

Interesting thoughts. We haven't had a flu shot in years and years and have been just fine. My theory is that when you get the flu shot, you are more likely to let your guard down and go place and wash your hands less. Kind of like you feel protected from sickness. When you don't get the shot, you feel like you need to step up with the care and protection.

With the idea of traveling sometime in the next year (to Africa) I have thought of the flu shot this year, but haven't done it. And most likely wont.

TopHat said...

The thing I find interesting is that Canada doesn't give the H1N1 vaccine to pregnant mothers before 20 unless there's a reason (big outbreak in the area), but the US isn't showing that caution. It just concerns me when two large medical associations (Public Health Agency of Canada & the CDC) have different recommendations. I'd err on the cautious side.

Permission to Mother said...

I usually don't like to post about vaccines because on other forums and boards the topic attracts less than helpful posts (and an equal amount of hysteria). I appreciate all your thoughts. Everyone has contributed something useful.

doctorjen said...

I think there is a fair amount of regional variation in case numbers. I'm in the midwest (central IL) About 3 weeks ago I read an some internet article (? on yahoo or some where) about how there really weren't that many cases and I was surprised because I was drowning in the flu in my own practice. Our health dept will only accept test swabs from hospitalized patients, so most of our confirmed cases were in hospitalized folks, but I saw so many people with the same symptoms (and about half had positive nasal swabs for influenza A as well) that I assume they had H1N1 as well. Many of the folks I saw had what I'd describe as a mild flu like illness - fever, body aches, URI symptoms, but manageable with symptomatic care and rest and were better in a few days. I did, however, have several very ill clients (all of these were confirmed H1N1 cases) The sickest 2 were a 5 year old boy with previous mild intermittent asthma and a 28 week pregnant woman. The 5 year old had a secondary pneumonia (diffuse pneumonia that seemed to act like an atypical such as mycoplasma) and was hospitalized with hypoxia and dehydration. He was in the hospital 4 days, but missed 2 weeks of school overall. The 28 week pregnant woman also developed a large secondary pneumonia, and was really sick for several days - we were worried about a possible empyema and need for a chest tube, but she finally started to improve after 4 days or so in the hospital. I had about 5 other admissions with it as well - an 18 week pregnant woman admitted with dehydration and vomiting (she was better quite quickly with hydration - although she was mildly ill altogether for 7-8 days) and 4 kids. 1 of the kids would not have been sick enough to admit except for being just 5 weeks old, so he was admitted for a sepsis work up since he had fever. He was otherwise not very ill (he was fully breastfed) and he recovered quickly, although his poor dad was much sicker at home. One other 15 yr old pregnant client had confirmed H1N1 (tested in the emergency room) at 32 weeks, but was not sick enough to need admission and recovered within about 5 days.
My perception in the last week is that it is dying down here, I think I've seen maybe 2 folks this week with a flu like illness, as opposed to the 6-10 a day I was seeing 3 weeks ago. A nearby hospital, though, did have several pregnant and immediately postpartum women end up sick enough to need mechanical ventilation, which is pretty scary.
I feel relatively neutral about vaccination - I'm not as worried about the "new and experimental" nature of the vaccine, as it is just a flu vaccine, just a different strain that the seasonal flu vaccine. We aren't giving it in the office, but more because we are so far down the distribution list by our health dept that we probably wouldn't get any vaccine until next year. I had the vaccine myself, though - I care for a lot of pregnant women and newborns and I worry that I'd work all day with cold symptoms thinking I just had a cold, then turn out to have flu and have exposed a bunch a folks!

Permission to Mother said...

Jen, I appreciate all your insight. My practice is very different from yours in terms of the number of flu like illnesses I see.

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