92.5%

I saw twenty-seven patients today. It was busy. There were several add-ons to an already packed schedule. I book 15-minute appointment slots. I have colleagues that book 10-minute appointments but I just don’t see how one can possibly deliver good medicine in such a short period of time. So for me, having an extra patient booked every hour makes for a really busy day.

Of the twenty-seven patients, no word of a lie, twenty-five came in because of cold and cough symptoms and only one patient left with a prescription for antibiotics. One. Did they all need to be seen? Absolutely not. I’ve been coughing for five weeks and haven’t thought to see a doctor. It’s a virus. It will get better on it’s own. If it doesn’t it’ll be pretty obvious and will declare itself with fever, chills, shortness of breath and exhaustion.

I like educating my patients about colds and flu. But damn me if they don’t remember the advice on a year to year basis. It can be really frustrating – for them and for me. They’ve taken time off work to see me, they feel awful and just want to get better. I understand that. But when they see everyone else around them with the same symptoms isn’t it obvious to them that going to see their doctor is kind of useless?

After the day I had, apparently not.

I just hope tomorrow something a little more interesting happens.

Oblivion.

What’s worse than one kid being sick?
How about three? Each one on the tail of the previous. Just as the eldest turns a corner towards the healthy side of the force, her baby brother spikes a fever and her other brother’s cough takes a turn towards the dark side.

FML.

I am curled up in bed waiting for the 1/2 tab of Gravol I just took to kick in. I am beyond exhausted and still feeling the remnants from last nights’ gingerbread festivities (hence the Gravol).

If I prayed to God I would wish for an uninterrupted nights’ blissful sleepy oblivion. That’s not too much to ask for, is it?

Life Imitates Art.

I have always been a sucker for disaster movies.  If I’m laid up on the couch sick with the flu, or just need a go-to movie to watch, my husband always knows which film to put on.  Hollywood doesn’t disappoint – there are many to choose from, be it in the form of natural disasters like comets and asteroids threatening the Earth, or solar flares, or climate change causing another ice age – I have my pick of movies that I can watch over and over and over again.

There’s a certain suspension of reality from the movies I’ve listed below – how likely is it that we will see another ice age? I mean, really.  How likely is it that a comet or asteroid is suddenly going to be discovered that will hit us in just the right way to cause an extinction level event?  I always joked that if such a thing were to ever happen, I would want a front seat to watch it.  A giant asteroid hurtles towards the Earth and will destroy the planet?  Yes! Sign me up for a front row seat to watch it enter the atmosphere!

 

 

 

 

 

 

 

 

 

 

 

But then there’s the other kind of disaster movie.  The movie about a virus, spreading throughout a population.  There’s only been a few that I can think of, probably because it hits a little too close to home for most people.  You know the movies.  You’ve seen them.

These movies are a little harder to watch, especially Contagion.  Why?  I think that’s pretty much self-explanatory.  The likelihood of a virus causing illness and spreading quickly, infecting and potentially killing people, is well documented in human history.

The Black Death (aka the Second Plague) killed an estimated 75-200 million people in the 14th century.  It was caused by a bacterium called Yersinia pestis and was carried by rats.  Also known as the Plague, it ravaged most of Europe, and took almost 150 years for Europe’s population to recover.  The Plague recurred on and off for the next 500 years, causing smaller outbreaks in Spain, France, Sweden and Russia.

 

Smaller pandemics of cholera, typhus, measles and smallpox have been reported throughout the past 1,000 years:

  • The Italian Plague killed 280,000 people in the 1600s
  • In Southern New England, 30-90% of the population of the Wampanoag people died of leptospirosis
  • In the 17th century, the Great Plague of London killed an estimated 100,000 people
  • In Asia/Europe, in the early 1800s – the first cholera pandemic killed over 100,000 people
  • The second cholera pandemic, in the mid 1800s, killed another 100,000+ people in Asia, North America and Europe
  • In 1838, over 100,000 people died in the smallpox epidemic of the Great Plains
  • The third cholera pandemic affected Russia killed 1,000,000 people in the span of 8 years, between 1852-1860
  • 20,000+ people died of a typhus epidemic in Canada, in 1 year in 1848
  • In 1875, 40,000 people died of measles in Fiji
  • Worldwide, in 1889, 1,000,000 people died of a flu pandemic

The 20th century alone saw some of the world’s worst pandemics.

  • The Spanish flu decimated the world’s population after WWI, killing an estimated 75,000,000 (75 millon) people, in 2 years!
  • In 1957, the Asian flu killed  2,000,000 people worldwide.
  • 1 million people died in 1968 of the Hong Kong flu.
  • 15,000 people died in India, in 1974, of cholera
  • More than 30,000,000 people have died of HIV/AIDS since 1981

The 21st century is almost a decade and a half old.  We have seen our fair share of outbreaks. Nothing as devastating as in the past, thanks mostly to sanitation, vaccination, antibiotic and antiviral medication, but outbreaks nonetheless.  One might argue that the world is due for one.

  • In 2003, SARS killed 775 people, mostly from China, Hong Kong and Canada; it spread to 37 countries from China
  • The 2009 flu pandemic (H1N1) killed about 15,000 people worldwide.

And this brings me to the real reason for this post.

For months now, news of the Ebola epidemic in West Africa has filtered through my Twitter and Facebook feeds.  The numbers of infected are astounding. I’ve seen estimates that by January 2015, over 1 million people will be infected, half of whom will die.  Ebola, historically, has had 90% death rate.  During this recent epidemic, about half of people infected are dying.  But that is still 50% case fatality rate.

So, what is Ebola? And why is it so deadly? Well, Ebola is a virus.  It’s actually quite pretty, I think.

My knowledge of virology is limited to a few hours of lectures on viruses from medical school.  It has an RNA-genome and it is kind of long for a virus.  Like most viruses, Ebola enters a cell by attached to that cell’s protein coat and fusing with it.  Once fusion of the two occurs, the virus empties it’s contents in the cell and the RNA attaches to the host cell’s RNA and takes over. Instead of the cell making its own proteins, it now has instructions from the viral RNA and starts making copies of the virus.  Once those copies are made the virus attaches to the cell’s outer coat, buds with it and leaves the cell.  By this time, the cell usually cannot function anymore, and so it dies.  The new virus copies get into the bloodstream where they are free to infect other cells and the cycle starts again.  The host immune system cannot keep up with this invader.  The virus makes special proteins that interfere with the hosts’ defenses and leaves the host vulnerable.

The Ebola virus especially likes the cells that line the blood vessels, as well as certain cells of the immune system and the liver.   After infecting these cells, it damages the integrity of the vessels, leaves the immune system’s defenders weakened, and damages the liver’s ability to form clotting factors.  The host then starts to bleed internally, hence the reason Ebola virus infection is also known as hemorrhagic fever.  The host bleeds internally, eventually causing death.

By the grace of God, if you so believe, Ebola virus is not airborne.  This means that it’s not present in the air and cannot be transmitted from being coughed on, sneezed on, or breathed upon.  Infection with Ebola occurs when bodily fluids (blood, feces, urine, emesis) from an infected host are mixed with a healthy host.  Most of the people who have gotten sick in Africa were family members and health care workers caring for the sick, and sadly, the dead.  The WHO recommends avoiding contact with the sick whenever possible, regular hand washing with soap and hot water, and discourages traditional funeral rites of washing and embalming the bodies of the dead.  The virus can be killed with heat (heating for 30 to 60 minutes at 60°C or boiling for 5 minutes).  Quarantine remains an effective method of controlling the disease.

I’ve often joked with friends and family that the world is due for a pandemic.  It’s been almost a hundred years since the Spanish flu pandemic.  The seasonal flu is nothing to joke about – the very young and the very old, still die every year from regular, joe-schmoe influenza.  There is a vaccine developed every year against the strains that most likely will be in circulation.  Since 2009, the vaccine now protects again H1N1 as well. Our office is getting ready for our annual fall classic – the Flu shots are arriving tomorrow and we are starting “flu shot” clinics next week.

But something in the news recently has me a bit worried. Earlier this week, it was reported that a traveller from West Africa boarded a plane in Liberia and landed in Dallas, Texas.  Asymptomatic at the time, he passed through whatever checkpoints were in place and entered U.S. soil.  A few days later, he started getting sick and presented himself to the local ER.  He told the triage desk his travel history, was seen by a doctor, given a script for antibiotics and was sent home.  He returned to the hospital 4 days later, very ill, and was diagnosed with Ebola virus.

Yes, folks. Ebola virus is now in North America.

I have one question.

How the FUCK did this happen?!?!?

Why are planes from West Africa being allowed to land?  If such a plane does land, why aren’t those travellers being immediately quarantined and monitored for symptoms?  Have we learned nothing from SARS and H1N1?

I wouldn’t want to be that triage nurse in Texas who took the travel history information from the Ebola patient and failed to forward it along to the attending physician.  I’d like to think that physician, had he known his patient had recently been in Liberia where there is an Ebola outbreak occurring, would have immediately notified the Centers for Disease Control and Prevention (CDC), and locked down his hospital. But no, that physician apparently didn’t know of the travel history, the patient didn’t bother to mention it again, and he was sent along his merry way to infect his family and God-knows who else.

Apparently, the man went back to the apartment complex where his family lived, started getting progressively more sick, was actually seen vomiting outside the building before being taken back to the ER where he was eventually diagnosed.  Does this not alarm anyone?  When I read the news report to my husband, he made an interesting observation. One that actually is a bit frightening.

Who cleaned up the vomit which likely was teeming with Ebola virus?

Did a dog come by and lick the vomit? Did that dog go back to his owners?  Is the dog sick? What will Ebola do in a new host species? Has the virus mutated? Can it become airborne?

According to that report yesterday, 18 people have been identified as being in contact with this individual.

Today? The Texas health departmentt said there were 100 potential contacts.  “Dallas County officials said more than 80 had direct or indirect contact with the patient.”

Well, which is it?  Indirect contact shouldn’t be a concern with Ebola, right?  Only direct contact, like family members cleaning up vomit or feces, or wiping the face of their sickened family member; or the maintenance worker of the apartment complex told by his bosses to clean up the vomit outside the building?

Today it’s 100.  Tomorrow it could be 1000.

Is this the beginning of next pandemic I joked earlier I thought we are due for?

In those two movies I love to watch, Outbreak and Contagion, the CDC takes control of local health departments and gets the epidemic under control.  Is life about to imitate art?

For all of our sakes, I certainly hope not.

 

 

 

 

 

 

 

 

 

-18C and I’m happy.

That cold snap I’ve been wanting to happen has finally happened.  And funnily enough, my household has been well for the past 3 weeks.  Coincidence?  I think not!!

I won’t belabor the point, but it’s been a brutal fall for cold viruses and Influenza.  See my previous posts.  I have been inundated the last few weeks with patients coming in for their flu vaccines.  Better late than never, I say.

It’s a refreshing change not to have to deal with the constant running noses, running around to find the thermometers, running out of baby Tylenol for the umpteenth time.   The house is healthy.  Yay!

So, you won’t hear any bitching about the deep freeze we are having.  I welcome it.  Take that, viruses!!

The Autumn Classic In Doctor Land.

Ah … Fall.

Some people mark the beginning of fall by the calendar date, the changing of the leaves, others by the start of the World Series.  Me?  Fall begins when the shipment of flu vaccine arrives in the office.

Fall came last Friday in a pretty package containing 160 doses of flu vaccine.

Influenza.  The Flu.  Most people use the term “flu” synonymously with “cold”.  The two are very different.

I’ll never forget the first (and only) time I had Influenza.  It was January, 2000.  I was heading back to medical school after the Christmas holidays.  While on the train, I started getting a scratchy, sore throat.  I woke up the next morning, feeling like I got hit by a truck. Within 6 hours, I had a fever of 39.8C (103.5F), my entire body was wracked with rigors, my head felt like it was going to explode.  My friends watched me deteriorate in class, apparently I looked weaker and paler by the minute and someone took pity on me and drove me home.  That night, I slept on the couch and watched re-runs of “The X-Files”.   I had to change clothes at least once very 2 hours due to drenching sweats.  My roommate called her mother who was a family physician and offered me an anti-viral, but I was pretty incoherent from the fever and declined.  In retrospect, I probably should have taken it.  The next day was no better, and there was no way I could go to class, so I basically lived on that couch for a few days.  Tylenol, Advil and Gatorade were my friends.  By the end of the week, the fever had broken, the muscle aches were gone, but I was left with a horrible cough which lasted about 4 weeks.  (Turns out I also got bronchitis after that).

Did I mention that was the first year I’d gotten the flu shot?

Riight, so it was also the year that I had influenza, bronchitis and laryngitis, pretty much back to back.  It was also the first year I trekked back and forth inside a hospital to get to my classes.  Such a glamorous life that was.  (I secretly loved it). I had never been that sick for that long.  It’s interesting to note that I haven’t been that sick since!  Obviously, I contracted a different viral strain which the flu shot didn’t protect me from.  It happens.  I was young (hey, still am!) so was able to fight the virus.  The extremes of age often aren’t so lucky when it comes to influenza.

It wasn’t always the case though.  The great flu pandemic of 1918 wiped out close to 50 million people.  The Spanish Flu decimated the world’s population (then, 1.36 billion) in a little over a year.  Most victims were healthy young adults, in contrast to most influenza outbreaks, which predominantly affect juvenile, elderly, or weakened patients (from Wikipedia).  Its been said that the Spanish Flu was deadlier than the Black Death and in fact, this flu killed more people in 24 weeks than AIDS has killed in 24 years, more in a year than the Black Death killed in a century!

Remember H1N1?  Much ado about nothing, in my opinion.  Not to be nihilistic, but we ain’t seen nothing yet.  The big one is coming.  I don’t know when, I don’t know how, but we’re due for a real pandemic again.

So, I got my flu shot again.