Swine Flu

[Gidget]

With the recent outbreak in our steak and neighboring wards I must say this is the first time I have actually been concerned about any flu. Probably because I am pregnant but I am more scared of my daughter getting it. And we have a few trips coming up in the next 6 weeks, all involve flying. For the Dr's out there on CUF, what can I really do to lessen the chances of illnesses like these? We have to get on these planes and we have to attend church eventually. Is washing our hands frequently the only thing we can do?

[FN Phat]

With the recent outbreak in our steak...

I always thought that the H1N1 came from pigs.

[FMCoug]

I think the swine flu is probably over-hyped by the media ... however, I am convinced that some sort of super-flu is what is ultimately going to do us all in.

The 1918 flu killed 50 million people worldwide. And that was before the world became so small with air travel, etc. If some bug like that comes along that is resistant to treatment, vaccination, etc. we're done for.

That's my bright thought on this game day morning.

GO COUGS!

[Fiyero]

At Uintah high school here in Utah, 144 of the 1150 students (13%) stayed home on Tuesday because of Swine flu symptons.

On Wednesday, it was 192 (17%).
On Thursday, it was 245 (21%).
On Friday, numbers not reported, the principal kept school open but canceled the football game.
As of today, the school is still planning to be open next week.

So Gidg, the answer is to not attend any football games.

[doctorcoug]

Go talk to your ob. There are specific guidelines from the CDC in regards to pregnant women. Your population is at a much larger risk than most Americans, so I'd get his/her advice.

[Viking]

Go talk to your ob. There are specific guidelines from the CDC in regards to pregnant women. Your population is at a much larger risk than most Americans, so I'd get his/her advice.

So, Doctorcoug, since Mrs. Viking was exposed to my case of the swine flu 4 months into her pregnancy, is there a chance she developed antibodies for her and superchild #3?

[doctorcoug]

So, Doctorcoug, since Mrs. Viking was exposed to my case of the swine flu 4 months into her pregnancy, is there a chance she developed antibodies for her and superchild #3?

That depends upon whether or not you actually had h1n1. The rapid screen for influenza a couple of months ago had a false positive rate from about 40-60%.

The ER docs admit patients with a diagnosis of influenza, and then I go talk to the patient and use my brain and diagnose the patient with croup. We rely on faulty lab tests and don't use our brains.

So, it is possible you had it, and it is possible you just had some other viral disease.

[Viking]

That depends upon whether or not you actually had h1n1. The rapid screen for influenza a couple of months ago had a false positive rate from about 40-60%.

The ER docs admit patients with a diagnosis of influenza, and then I go talk to the patient and use my brain and diagnose the patient with croup. We rely on faulty lab tests and don't use our brains.

So, it is possible you had it, and it is possible you just had some other viral disease.

Presume I had H1N1.

[doctorcoug]

Presume I had H1N1.

Odds are you didn't, unless you were in Brazil about a week before you got sick.

[Gidget]

So we can't do much but wash our hands and not go to football games? Come on people.

[ERCougar]

The ER docs admit patients with a diagnosis of influenza, and then I go talk to the patient and use my brain and diagnose the patient with croup. We rely on faulty lab tests and don't use our brains.

If only that ER doctor had completed 3 months of a family medicine residency!

[doctorcoug]

If only that ER doctor had completed 3 months of a family medicine residency!

Ya, that didn't come out right. I was referring to a specific situation that happened.

I bet most ER docs have no idea what the positive predictive value of the rapid influenza screen is. I'd bet that most FP docs have no idea, either.

You can't make the diagnosis of influenza with a positive influenza A screen. You know that, yet it happens all the time.

It pisses me off when doctors don't remember that all lab tests aren't perfect. My angst is directed at ER attendings often because I see manysoft admissions based on a lab value without confirmatory symptoms.

[ERCougar]

Ya, that didn't come out right. I was referring to a specific situation that happened.

I bet most ER docs have no idea what the positive predictive value of the rapid influenza screen is. I'd bet that most FP docs have no idea, either.

You can't make the diagnosis of influenza with a positive influenza A screen. You know that, yet it happens all the time.

It pisses me off when doctors don't remember that all lab tests aren't perfect. My angst is directed at ER attendings often because I see manysoft admissions based on a lab value without confirmatory symptoms.

Uh, yeah, I bet most ER docs know exactly what the sensitivity, specificity, and likelihood ratios of the influenza screen are. I'm sure you realize that PPV's are incidence-dependent, and are thus almost meaningless with regards to influenza, as this changes by the week and the region. Having done both FP and EM residencies, I'll tell you that EM focuses very heavily on test characteristics, much more so than my FP residency did. I'm sure that's residency-dependent.

You also are aware, I'm sure, that influenza can cause croup?

[doctorcoug]

Uh, yeah, I bet most ER docs know exactly what the sensitivity, specificity, and likelihood ratios of the influenza screen are. I'm sure you realize that PPV's are incidence-dependent, and are thus almost meaningless with regards to influenza, as this changes by the week and the region. Having done both FP and EM residencies, I'll tell you that EM focuses very heavily on test characteristics, much more so than my FP residency did. I'm sure that's residency-dependent.

You also are aware, I'm sure, that influenza can cause croup?

Au contraire, the PPV is very important to the influenza diagnosis. I have contacted my state health department to get our region's incidence so that I could calculate the PPV, and in turn, the false positive rate.

I took the time to investigate so I could be the best physician possible. A simple 3 minute phone call was all it took. Not too hard for physicians to do for a disease that gets so much play.

In regards to the croup vs influenza, we don't treat labs, we treat patients. I wasn't the only person that thought the influenza diagnosis was crap. The pediatrician called it LTB.

[ERCougar]

Au contraire, the PPV is very important to the influenza diagnosis. I have contacted my state health department to get our region's incidence so that I could calculate the PPV, and in turn, the false positive rate.

I took the time to investigate so I could be the best physician possible. A simple 3 minute phone call was all it took. Not too hard for physicians to do for a disease that gets so much play.

In regards to the croup vs influenza, we don't treat labs, we treat patients. I wasn't the only person that thought the influenza diagnosis was crap. The pediatrician called it LTB.

No one in the field who seriously discusses testing characteristics uses PPV. I'm glad you calculated it, but I'm not sure how much more you need to know than high, medium, or low, in making a treatment decision. But, PPV is an awesome med student exercise.

Uh...LTB is the same as croup. Not sure how this disputes my point that croup can be caused by influenza, but ok.

I'm gonna give you a tip, my little intern. I can't really defend what I can't see, but these "soft" admits you talk about--they likely come from experience. Since you're all into EBM, you'll understand that the incidence of badness in the ER is much higher than the incidence of badness in your little clinic. Thus, your treasured PPV on about everything is going to be orders of magnitude higher. In simple terms, we see a lot of crap. We see a lot of crap that was sent home by their PCP. We see a lot of crap that was sent home by their PCP earlier that day. I don't fault the PCP because it's not their job to be uber-vigilant--they should play percentages. Our job is to play potential badness.

I know it's "cool" (or makes you feel smart or whatever) to criticize the ER docs, but the sooner realize that both doctors and the nurses are probably clinically smarter than you, the easier your life will be and the more you'll learn. There's nothing, and I mean nothing, more annoying than a know-it-all resident. Check that--a know-it-all intern is more annoying. You're in the hospital all the time anyway. Just admit the patient and learn something.