Tag Archives: cough

by

Who would I be?

If I have had PANS since birth, who would I be if I had not contracted it?

No one knows. We are still arguing about whether PANDAS and PANS exist. But, my daughter says, we make up all the words. The definitions of illnesses CHANGE over time, and what an illness MEANS. Tuberculosis was an illness of poets and people too noble for this world, until microscopes became advanced enough to see the tiny bacterium, and then it became an illness of the crowded unclean poor. Medicine and science continued to study it. Once we recognized that it is an airborne illness, tuberculosis sanatoriums were set up, to quarantine people. My mother was diagnosed with tuberculosis when she coughed blood 8 months pregnant, so I was born in a sanatorium and avoided contracting tuberculosis as a newborn.

Antibodies cross the placenta, even though the tuberculosis bacterium does not. Usually infants contract tuberculosis and die, at least when I was born. The antibodies can trigger PANS or PANDAS.

The antibodies prime the fetus’s immune system. This makes sense, right? The fetus has a sick mother and best if its’ immune system is ready to fight.

Did my younger sister have it? I do not know. Not as badly, would be my guess. My mother said that as kids, we’d both get sick, but I got sicker. We both had strep A many times. My sister got mumps, off from school for three weeks, and I did not get it. But I got everything else.

Now the estimate for children with PANS or PANDAS is 1 in 200. This is enormous. A high prevalence. Antibodies, that I suspect are adaptive and lie in readiness for a pandemic or a crisis. And now we have had another pandemic, with the last really world wide bad respiratory one 100 years ago. Is the prevalence rising because of the pandemic or are we figuring out some of the cause of behavioral health illness or is the definition of illness changing or all three? I think all of them.

My cousin’s mother had polio either during her pregnancy or very soon after. My anthropologist uncle took his family to Bangladesh, where he was doing linguistics. So does my cousin have PANS or PANDAS? I do not know.

And what of my children? My pregnancy with my older child was fourth year medical school and went well. My pregnancy with my second was very complicated. I was in my first year of work as a rural Family Practice doctor and working too hard. I ended up on bed rest for three months and on a medicine. Is labor at 23 weeks an illness? Does it affect the fetus? I was on medicine from 23 weeks to 37 weeks. What effect does it have?

Medicine is still changing and changing quickly. We don’t know. There is so much we do not know.

_______________

PANS/PANDAS: https://www.pandasppn.org/guidelines/

_______________

The photograph is me and my sister, in about 1967ish. I do not know who took it.

by

Covid-19: working in healthcare

So, should healthcare workers be required to have Covid-19 vaccines?

Yes.

What is the precedent?

Take tuberculosis, for example. Airborne, very contagious. I was born in a Knoxville, Tennessee tuberculosis sanatorium, because my mother coughed blood a month before she was due and got quarantined for active tuberculosis. Yes, the state could quarantine my mother. I was removed immediately at birth because tuberculosis doesn’t cross the placenta. The antibodies do, but the infection doesn’t. However, newborns usually catch it and die very quickly. I was lucky. My father and grandparents took care of me for 5 months. Then my mother was allowed out (after 6 months total) but was not strong enough to take care of me. So I was taken to my maternal grandparents for the next four months, and did not touch my mother until I was 9 months old.

My mother was taking 36 pills a day at home, because you have to use multiple drugs to kill tuberculosis. It develops drug resistance very very quickly.

Well, so what, you say?

Healthcare workers in the United States are routinely checked with a ppd for tuberculosis. If it is positive, you cannot work until further testing. If you have latent tuberculosis, you are treated. If you have active tuberculosis, the treatment is longer and more complicated, here: https://www.cdc.gov/tb/topic/infectioncontrol/default.htm

My cousin then said, “Well, you don’t have to show the tuberculosis test to go in a restaurant!”

Well, not right NOW, because currently tuberculosis is under more or less reasonable control in the US. Remember that guy who came in to the US with active multi drug resistant tuberculosis and knowingly exposed everyone on that airplane? Great. I remember reading about that and thinking what a selfish jerk he was. And then the group of unimmunized people who went to India and all got measles. The US at that time did not bar anyone from returning, but asked them to finish a 3 week quarentine before returning to the US. One person did not do that. There was a measles outbreak in the midwest which cost the CDC (and therefore you and me because those is tax dollars) millions to trace, quarantine and clean up. So there was discussion at that time about whether the policy should be changed and we should not allow US citizens with known infectious diseases to come in on airplanes. We DON’T allow immigrants in with infectious diseases: they are tested for tuberculosis if coming from countries where it is endemic.

So, if we had a huge outbreak of tuberculosis, we WOULD have quarantines and shut downs.

I have tested a patient for tuberculosis, about two years ago. Her son had been diagnosed with active tuberculosis. We tested her with a blood test and then repeated it in three months. Negative, hooray. In residency I also saw a case of miliary tuberculosis. That is where the tuberculosis is growing so well in the lungs that it looks like little grains of rice in the lungs on imaging. Not a good thing.

My cousin: “You shouldn’t have to put something in your body to work.”

If you have tuberculosis, you do not get to work in healthcare, because you can kill your patients. I think that this is a good thing, to not kill our patients.

I am submitting this to the Ragtag Daily Prompt: starspangled. Keep America Healthy, how about that?

by

pig in blankets

For mindlovesmisery’s Heeding Haiku catch reality: With a nasty cold, I have to be off from work for long enough that I won’t cough talking and get pneumonia again. But the work piles up…

pig in blankets

virus swollen drain
balance, rest while paper piles
return to work soon

You noticed the pig in the blankets..but did you notice the other?

aha!.jpg

Miss Boa likes the blankets. A purring comfort for me.

by

Influenza 2016

No influenza cases so far this year in my clinic.

I watch the flu map faithfully each week, as I try to get my stubborn patients to get their influenza vaccine. It takes up to two weeks to get them immune, if it works. It works most years about 80% f the time. When it doesn’t work, it’s because either their immune system didn’t respond or because the influenza virus has traded genes enough that the guess six months before on which way it will evolve, is wrong.

Here is the CDC weekly influenza update link: http://www.cdc.gov/flu/weekly/fluactivitysurv.htm.

If you click on the FluView Weekly Influenza Surveillance Report, scroll down. My favorite to show patients are the Outpatient Illness Surveillance, which maps this year’s rise in influenza in the US each week, compared with past years. We are having a late year.

My other favorite is the next one down: ILIState Activity Indicator Map. It changes color each week by state as the influenza reports come in. Arizona turned red this year about a month ago, after Puerto Rico. Red is high activity level. The rest of the country was dark green, low, or light green, but has steadily been turning yellow green, yellow, orange…. Washington State is still green. But now only a few states are green and it’s still on the rise. If we continue to have unseasonably warm sunny days, like the last four days, we might avoid the influenza. But if it gets wet and cold again: boom. Like a sneeze, spreading. This is the first week we’ve had seven red states. I have been wearing a mask in clinic every time I see someone coughing. And I got a cold anyhow, but it is not influenza and I don’t think it’s strep A, thank goodness.

I said influenza is airborne but it isn’t. Or there is controversy. It is at least droplet spread, but sneezes count. Apparently influenza can get to people 6 feet away. Wear your space suit with the oxygen filter to the grocery store. http://www.cdc.gov/flu/about/disease/spread.htm — lots of information about the influenza virus. Is all of it 100% correct? Don’t be silly, this is science, not a religious text: science changes, just like the flu virus.

This year, a CDC alert was faxed to clinic on February 1: http://emergency.cdc.gov/han/han00387.asp. It is all very calm and clinical, with this sentence in the second paragraph: “CDC has received recent reports of severe respiratory illness among young- to middle-aged adults with H1N1pdm09 virus infection, some of whom required intensive care unit (ICU) admission; fatalities have been reported.” I called my son and said, “Get your flu shot now.” If you read the rest, it says ages 20-50 as the “young” and “middle-aged” adults. Not the group that we expect influenza to hit, but that is the group that got hit in the 1918-1919 influenza.

Get your flu shot… be careful out there.

 

I took the photograph two days ago with my phone: Boa was on my lap and I wrapped her in the shawl I’d knit, and she was so relaxed…. that’s how we need to take care of everyone with influenza.