Influenza: check your pulse!

This year influenza is bad. My key test in influenza is not a chest x-ray. It is taking a resting pulse and a walking pulse.

Why? Influenza can cause a walking pneumonia. Walking pneumonia is where the lungs are infected throughout and there is tissue swelling. It is different from a lobar pneumonia. In lobar pneumonia people run a higher fever, look sicker, and on the chest x-ray, that part of the lung is white: infection, not air.

In walking pneumonia, the chest x-ray may be read as normal. This is because all the lung tissue is equally swollen. The swelling means that there is less air space. The person may feel ok at rest. They feel exhausted when they walk because the heart must take up the slack for the missing air space, the swollen lungs. At rest this week one person’s heart rate is 84. After walking it is 124. Normal is 60-100, so 124 is like running a marathon: exhausting and hard on your heart and body.

I have patients saying “I was sick two weeks ago and I am still exhausted.” If their pulse is much over 100 after they walk, they cannot work until it comes down. If they work and wear themselves out, the lungs can’t heal. The treatment is rest. If they are at work with a pulse of 114 or 124, then they risk getting a secondary infection in already damaged lungs. They could die.

Check your pulse at home. Count the number of heartbeats in 60 seconds. That is your pulse. Walk around, sit down, and check again. That is the walking pulse. Over 100 is not normal.

This is a bad influenza. The tamiflu (oseltamivir) helps but works best in the first three days of flu. Check your pulse, be seen, rest and get well.

http://www.peninsuladailynews.com/news/three-die-of-flu-on-peninsula-public-helath-officals-say-a-fourth-death-said-to-have-been-in-seattle/

cracks

For the Ragtag Daily Prompt: fault.

I realized last night that I had not put up the prompt, and got back up to do it. My daughter called while I was thinking and told me about segmentation faults. I wrote the poem this morning.

cracks

people talk about me

whisper gossip
social skills aren’t right

they only see now

I had to grow in cracks
hold on tightly
find nourishment where I could
not fall
survive

if they could see my roots
if they could see
where I had to grow
no choice

maybe they would be kinder

yep, yep, yep

My daughter and two friends and schoolmates at Mount Saint Helens at the end of eighth grade. And what do you think is happening? Present, facing the speaker, yep, it’s a teacher going over the rules. Let’s get on with it. We know the rules. Face forward, mind might be elsewhere.

Setting up camp.

picnic table in the woods with containers to set up camp
Group camp at St. Helen’s
shelters tied over tents for rain protection.
rain preparation
Teachers and annoying parent chaperones with cameras
Teachers and annoying parent chaperones with cameras
8th grade audience at park
audience for each other
Seven 8th grade girls performing a song they made up.
group song

All taken in 2012 on the end of the year 8th grade trip to Mount St. Helens, to get the students together before starting high school. Huge thanks again to the teachers, the parents and the teens too.

Mount St Helen's
Mount St Helens

mother and child

I have a collection of parent and children pictures and sculptures. This is one. A mother ox and her baby. I was born in the Chinese Year of the Ox and so was my daughter. This little sculpture is about 3 by 2 inches, but both my daughter and I love it.

I am so proud of everyone who stood up for children yesterday, and for everyone who is saying, if it was MY child, I would want someone to stand up for them and for me.

Blessing and bring the children back to their parents.

teens high risk for addiction

What teens are at high risk for addiction?

Would you say inner city, poor, abused, homeless?

This study : Adolescents from upper middle class communities: Substance misuse and addiction across early adulthood. which I first saw in WebMd, says that the privileged upper middle and rich children are at higher risk  for addiction than many of their peers.

350+ teens in New England were studied.

Drug and alcohol use was higher than across country norms, including inner city.

Rates of addiction diagnosis by age 26 were
19%-24% for girls
23%-40% for boys
These rates are two to three times the norms across the country.

Rates for addiction diagnosis by age 22 were
11%-16% for girls
19%-27% for boys
These rates are close to the same in girls, but twice as high in boys as peers across the country.

The teens were often popular high achievers who are A students. Parents tended to drink more in those cohorts than the norms.

Also: “Findings also showed the protective power of parents’ containment (anticipated stringency of repercussions for substance use) at age 18; this was inversely associated with frequency of drunkenness and marijuana and stimulant use in adulthood.” That is, parents who sent a clear message that consequences for illegal and underage substance use including alcohol and marijuana would be serious, provided protection for their teens.

A second article: Children of the Affluent: Challenges to Well-Being says this:

“Results also revealed the surprising unique significance of children’s eating dinner with at least one parent on most nights. Even after the other six parenting dimensions (including emotional closeness both to mothers and to fathers) were taken into account, this simple family routine was linked not only to children’s self-reported adjustment, but also to their performance at school. Striking, too, were the similarities of links involving family dining among families ostensibly easily able to arrange for shared leisure time and those who had to cope with the sundry exigencies of everyday life in poverty.”

Other children’s perception of parenting examined included:

felt closeness to mothers
felt closeness to fathers
parental values emphasizing integrity
regularity of eating dinner with parents
parental criticism
lack of after-school supervision
parental expectations

This aligns with my observations both in my town and with patients. I see parents “check out” sometimes when their children are in their teens. “I can’t control him/her. They are going to use drugs and alcohol.” I told my children that if they partied I would NOT be the parent who says, “Oh, he needs to play football anyhow.” I would be the parent who would be yelling “Throw the book at him/her. Bench them.” And I saw parents of teens going out to the parking lot to smoke marijuana at a church fundraiser when it was still illegal. And saying “Oh, our kids don’t know.” I thought, “Your kids are not that dumb.” They invited me along. I said, “No.” And I really lost respect for that group of parents. What example and message are they sending to their teens? Yeah, cool, do illegal things in the parking lot, nod, nod, wink, wink.

Meanwhile, my children keep me honest. “You are speeding, mom.”

“Yeah,” I say. “You are right. Sometimes I do.” And I slow down.

burnt

This is for photrablogger’s Mundane Monday #129.

We were two of the three first responders to a house fire across the street and two doors down two weekends ago. The house was an inferno when we got there. Both the resident and two cats got out. The fire was in the morning. We returned in the evening and walked around. It is terrifying to see what melts, what explodes, how fast the destruction can happen.

And sending love to the injured and lost in Las Vegas and still thinking of all of the hurricane victims.

I wish today were mundane.

group

For the Daily Prompt: popular.

I was on Herron Island for two nights. We were the second responders to a house fire and called 911.

Are the gulls grouped for social reasons? For survival too. If there is a predator, those sleeping will be awakened by the others.

The hurricanes and the house fire: I am thinking about emergencies and emergency response and emergency preparedness. How are you prepared? The fire trucks had to come to the island by ferry and it took twenty minutes.

I am donating to Shelterbox, that sends disaster boxes all over the world, shelter, water filters, cooking equipment and food supplies. And crayons and a coloring book for the children. I hope they are arriving in all the places, wars, hurricanes and other disasters.

At what age should we talk to our kids about drugs?

I am a rural family physician and my recommendation: before age 9. Before third grade.

WHY? Your eyes are popping out of your head in horror, but my recommendation comes from surveying my patients. For years.

The biggest drug killer is tobacco. However, it takes 30 years to kill people. It is very effective at taking twenty years off someone’s life, destroying their lungs, causing lung cancer, heart disease, mouth cancer, breast cancer, uterine cancer, stomach cancer, emphysema, heart disease….

I ask older smokers what age they started smoking. This is informal. This is not scientific. But most of my male older smokers say that they first tried cigarettes at age 9. I think parents need to be talking to their children about cigarettes by age 9.

And then start talking about alcohol and illegal drugs and the terrible dangers of pills.

“My innocent child would never….” Unfortunately my daughter said that as a senior in high school in our small town, there were 4-5 kids out of the 120+ that were not trying alcohol and marijuana. But there are kids trying far worse substances. We have methamphetamines here, and heroin, and pain pills sold on the street.

The perception that pills are safe is wrong too. Heroin is made from the opium poppy and it’s rather an expensive process, not to mention illegal and has to be imported from dangerous places. But teens take oxycodone and hydrocodone, bought on the street, to get high. And now drug sellers are making FAKE oxycodone and hydrocodone and selling that on the street. It contains fentanyl, which is much much stronger. If the dealer gets the mix wrong, the buyer can overdose and die.

Talk to your children young! NEVER take a pill from a friend, never take someone else’s medicine, never take a pill to party! YOU COULD DIE! And if you have a friend that is not making sense, that you can’t wake up, DON’T LEAVE THEM! Call an ambulance. Your friend may have used something illegal, and may not want you to call an ambulance. But if you think they are too sleepy….. don’t take a chance. People can get so sleepy, so sedated, that they stop breathing.

And parents, you are the ones that have to set a good example. Don’t drink alcohol every night. Don’t use pot every night. Take as few pills as possible. Pills aren’t necessarily safe because they are “supplements” or “natural” — hey, opium and heroin are plant based! Stop using tobacco and if you have a hard time doing it, tell your children you are struggling. It takes an average of eight tries to quit smoking. Get help.

Lastly, we talk about childhood innocence, but we let kids babysit at age 11. That is the Red Cross youngest age. My daughter took a babysitting course at age 11 and babysat. If we think they are responsible enough to do CPR, call 911 and do the heimlich maneuver, shouldn’t we also be talking to them about addictive substances by that age?

Talk to your children about addiction young… so that they can avoid it.

I am submitting this to the Daily Post Prompt: calm. I am not calm about this topic, but the photograph is calm…. and if we can help more children and families…..

Taking care of Ebola is hard

“We may never know exactly how [transmission] happened, but the bottom line is that the guidelines didn’t work for that hospital,” said Frieden. “Dallas shows that taking care of Ebola is hard.”

From the Huffington Post: http://www.huffingtonpost.com/2014/10/20/ebola-hospitals-us_n_6018372.html

And for me, a lowly rural Family Practice physician, from the American Academy of Family Practice: “The first steps in preparing your office for a possible Ebola case are to make sure you have all referral contact information ready to go and that you educate each staff member on his or her role should a case present.”

There is only me and a receptionist. We don’t have hazmat suits. Actually I’ve been off sick, lung and vocal cord problems, for all of October.

We have masks, gloves, I do have a white coat that I almost never wear.

Also from the AAFP:”Appointment clerks and front-desk personnel taking calls for appointments should inquire about African travel history in patients calling for appointments for fever, headache, weakness, diarrhea, vomiting, muscle aches or bleeding,” said Mahoney. “Anyone with a positive travel history should be contacted by a provider to gather additional history and determine if public health authorities need to be involved before a patient even presents to the physician office.”

http://www.aafp.org/news/health-of-the-public/20141017eboladisprep.html

We are both going to get our influenza shots this week. Please get your influenza shot. There is a lot more influenza around than risk of ebola in the United States, and influenza kills many many people every year. And even if you “never get colds” and “have a strong immune system”, you might get a mild case of influenza and pass it on to someone who then dies of it. If you tell me “I got flu the last time I got the shot”, excuse me, but that is hooey. First of all, it takes two weeks for your immune system to respond to the shot, so if you got symptoms the next day it could be influenza but not from the shot. Maybe from being exposed to someone with influenza at the grocery store or your doctor’s office. Secondly, people say “flu” and often they mean stomach flu. Stomach flu is not influenza. Third, influenza changes all the time, so about 80% of the vaccinated people are protected most years. That’s right: two weeks after my influenza shot, I am about 80% protected. Not 100%.

Why are we getting vaccinated? For one thing, we are health care workers and we get exposed. And for another, the initial symptoms of influenza are the same as the initial symptoms of ebola. Actually the United States is really rather lucky that the ebola case happened before influenza really hit, because they look too much the same initially. Suppose that three of the quarentined people had come down with influenza….. confusion and panic initially.

So please get your influenza vaccine, because you not only help to protect yourself, but protect others and prevent panic.

Blessings!