OPINION
DOCTORS' Lounge
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La Grippe
Mary G. Barry, MD
Louisville Medicine Editor
[email protected]
T
he best (printable in a family pub-
lication) name for Influenza is the
Euro one. (1)
Like all primary care doctors,
I have seen thousands of flu pa-
tients in my lifetime; that number sadly
jumped by leaps and bounds this flu season.
What has frightened me about this flu
season is that so many people are not rec-
ognized as flu patients “because the flu swab
was negative.” My Snowbird patients are
in the hospital in Florida because “Her flu
swab was negative,” said the relatives, “and
then she got pneumonia and had to go in
the ICU.”
My local patients are told the same
things at these clinics, and almost imme-
diately end up in my office, with full-blown
bronchitis and triple the misery.
The Courier Journal has run multiple
stories about children and adults who died
of the flu this season. A common thread in
these is that same phrase, “His flu swab was
negative and he was sent home from the
clinic.” Within the week, they died in the
hospital of staphylococcal/pneumococcal
sepsis.
As of the first week of March, 114 chil-
dren in this country have died of flu. The
number of adults has been estimated by the
CDC as 56,000, but since flu is not accurate-
ly reported on death certificates that number
remains an estimate, sure to increase since
last year’s flu lasted until April.
By and large, in my book, these are
preventable deaths. Flu at 90-years-old is
not easy to survive. Otherwise, when the
clinician believes the flu swab instead of the
patient’s history and exam, the clinician is
nearly always wrong – dead wrong.
Therefore, I have begun systematical-
ly teaching my patients how to recognize
when they have the flu, and not something
else. Flu means Influenza, not the 48 hour
dreaded GI bug, which patients frequently
mistake for the real flu.
So far, only one person has successfully
answered the pre-quiz, which is one ques-
tion. No doctor has answered correctly (but
I only have asked specialists, since my part-
ners all know of course), nor any nurse, nor
anybody except an attorney I have known
since childhood, and he knew because he
had the flu last year, and remembered.
While you are mulling this over, what I
most often hear is fever, followed by body
aches, followed by a host of guesses – sore
throat, sinus problems, headache, diarrhea,
sleepiness, nausea, vomiting, runny nose,
and cough.
The correct answer for Sign is not tachy-
cardia or fever or rhonchi or throat redness
or “looks sick.” The correct answer is simply:
Flu Eyes; slitted/narrowed and reddened
eyes. The lower inner eyelids are reddened
more than the upper, the eyes are smallish
and narrowed, as though photophobic, al-
though that is not a symptom. Normally,
I walk in the room, take one look at the
patient, and know what is going on.
Have you thought of the Symptom? It’s
also simple: the overwhelming compulsion
to lie down. We must go to ground. We must
simply be FLAT. We long for our beds, we
must go to bed, we cannot remain sitting.
We gotta lie down NOW and stay there, for
hours and hours and hours.
Therefore, class: What ONE symptom is
correctly and universally diagnostic of the flu? I have not yet found a patient with in-
fluenza who was not longing to be flat, if
not actually lying on the exam table when
I walked into the room.
And, for you clinicians out there: What
ONE sign is universally diagnostic of the flu? (continued on page 32)
Therefore: if you think you have the flu
APRIL 2018
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