Medicine For People!

March 2015

Sneeze

Influenza type A: Not an Ordinary Flu

  • Type A Influenza Diagnosis and Treatment
    • Not an Ordinary Flu
    • Diagnosis
    • Treatment
  • Carolyn Latteier
  • Fitness: Principles vs Pipe Dreams
  • Welcome our Newest RN
  • Editorial Help Wanted
  • Thanks to You

Last month's newsletter outlined the differences between common viral illnesses (casually referred to as "the flu" or on the East Coast as "the crud") and type A influenza, the serious flu that can knock you flat, send you to the hospital, or – in extreme cases – lead to death.

This month let's talk about how doctors diagnose and treat type A influenza.

Diagnosis

Health departments recruit representative primary care practitioners around the country who report the number and types of influenza-like illness circulating in the community. When a high proportion of patients are showing up with type A influenza, you will see this on the nightly news in a brief report highlighting increased or decreased influenza activity. The results of these reports influence providers' decisions on diagnostic measures to be taken when people come with influenza-like illness.

Influenza-like illness, abbreviated ILI, is diagnostic shorthand for "looks like the flu, quacks like the flu, but we don't have definite proof." Given the ever present economics of medicine, many times looking and quacking is as definite a diagnosis as we are going to get.

We can employ 15-minute office tests that use a specimen from the patient's nose to detect type A influenza. The trouble is, they aren't perfect, picking up about half of all cases of type A influenza. If they are positive, they are about 20 percent likely to be wrong. That's a tough sell, and many physicians don't buy it.

Instead, we rely on a careful history and physical examination. When necessary, a blood count or, less often, a chest x-ray can help us pick out those people who require more careful evaluation.   

Treatment

If it looks as if you have Type A Influenza, and you've gotten to us within 48 hours of the onset of symptoms, we can use an antiviral drug called oseltamivir, currently available only as the branded Tamiflu. As of this writing, it is still effective against most strains of type A influenza.

In addition we may medicate you for complications such as pain or cough. We'll recommend smaller doses of oseltamivir for your family members to prevent them from catching the disease.

Forty-eight hours is not a very long window for treatment. You may wish to ask your doctor for a prescription and keep it in the freezer. This way it will maintain its potency over many years. Based upon the description in last month's newsletter, you should be able to identify type A influenza, should it occur, and start the oseltamivir right away. As with any antiviral, the sooner you start the better.

Carolyn Latteier

Sometimes, folk sayings are wrong. One of those sayings is "You can't turn a sow's ear into a silk purse." I know this is wrong, because for about 12 years, I have sent rough and inscrutable screeds, the prose equivalent of a sow's ear, to editor Carolyn Latteier. These have often been digressive, unnecessarily complex, sketchy in parts, not well organized, and just not worth reading. Now, when I sent these screeds I did not realize they were complex, sketchy, poorly organized, etc. Only when Carolyn returned the literary silk purse did I see what could be done.

So, dear Readers, brace yourselves. Carolyn's other responsibilities require her to step down and forgo her lavish share of the Medicine for People revenue and public acclaim.

I hereby make public confession of my great admiration for and appreciation of Carolyn's help over these years. Without her help, my life would've been much more challenging, or our newsletter product much less valuable to you the reader.

Fitness:   Principles vs Pipe Dreams

If you missed this on our Facebook page, read it. This tears up all the exercise myths and outlines the basics of real fitness.  Rienstra Clinic Page on Facebook.

Welcome our Newest RNs

Welcome to Dawn Helman, RN, working with us one or two mornings each week. Dawn went to school with our own Bonnie Corra . Bonnie happens to be the mother of our other nurse, Lissy Corra, RN, BSN.

Editorial Help Wanted

If you have professional literary experience and are interested in helping me with this newsletter, please contact me. Carolyn and I have had a lot of fun writing this newsletter to this point and I'm sure my new editor and I will, too.

I need the help. The readers will certainly appreciate your efforts. Literary fame awaits!

Thank you!

Everything we do, we do with your support. Thank you for your confidence in us and your contribution to our practice. People keep getting well, so we do have space in our schedule for your friends and family. Please keep us in mind should they need medical help.

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Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington.