Louisville Medicine Volume 65, Issue 11 - Page 33

OPINION DOCTORS' Lounge SPEAK YOUR MIND If you would like to respond to an article in this issue, please submit an article or letter to the editor. Contributions may be sent to editor@glms.org or may be submitted online at www.glms.org. The GLMS Editorial Board reserves the right to choose what will be published. Please note that the views expressed in Doctors’ Lounge or any other article in this publication are not those of the Greater Louisville Medical Society or Louisville Medicine. La Grippe Mary G. Barry, MD Louisville Medicine Editor editor@glms.org 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 31