White Coat Underground

I got home pretty late last night. The last week or two has seen a huge rise in influenza-like illness (ILI). Late in the evening, I began to get a scratchy throat and chills, but sometimes fatigue can feel like flu. I went home and had a nice dinner and a shower and felt a bit better.

At about 3 a.m., a little knock on the bedroom door woke me from a deep sleep. My daughter walked in crying, “my throat hurts!” She never gets up in the middle of the night. My wife sent me to the other room to sleep, gave her some motrin, and lay back down. Within a half an hour, the kiddo broke into a sweat and started demanding french toast sticks. In another hour or so my wife woke me up begging for mercy. I crawled into bed with the little one and we both fell back to sleep.

So I don’t feel flu-ish this morning, but I am tired. I was listening to a local morning radio show on the way to the office and heard them talking flu. They were reporting on a woman who developed a strange neuromuscular disorder and also had received a flu shot. They were remarkably skeptical, but still, I just had to call in. The call screener told me they were done with the topic, but then they got back into it, so I called back and they put me on. They asked pretty reasonable questions, the same ones I hear every day, and actually let me de-bunk some of the myths out there. Score one for the good guys!

Tonight, barring any further flu-like symptoms, I’m off to East Lansing with friends to hear Michael Shermer speak. But I’m sure I’ll get a few flu pages during the talk. Tomorrow is a special day—my county health department is rolling out the H1N1 vaccines. My kiddo doesn’t know it yet, but we’re going to get that taken care of tomorrow, probably followed by ice cream. It’s a good thing she doesn’t read my blog, because this one is going to take some stealth.

Comments

#1 Denice Walter
October 23, 2009

Last night, Anderson Cooper had as a guest, one of the NY nurses(protesting mandatory H1N1 vaccines for health care workers)giving the “reasons”(sic) with which we are so familiar (plus,”I never get sick!”). Fortunately, he also had a sane doctor on, providing the opposing view.It seems the mandatory order has now been rescinded, not because of the woos’ *fabulous* legal arguments(choke) but because the vaccine is in *short supply*.In addition, searching for an H1N1 vaccine for my SO(who has asthma), I found that my state has good web info resources(NJDHSS) and a phone line,however,he’ll have to wait a while for the vaccine. Hope you guys feel better.
#2 lori b
October 23, 2009

hmmm…hayden is home sick today too. uh oh.
#3 Anonymous
October 23, 2009

Wait a sec. Your daughter had flu-like symptoms last night and now you’re planning on getting her a shot tomorrow? Isn’t that cutting it close? Or is that another myth?

My son was refused a H1N1 shot yesterday at his school because the nurse thought she heard something funny in his chest. Sure enough, he has a high fever today. I knew those shots offered at school sounded too good….
#4 Caro
October 23, 2009

I’m getting increasingly worried about the flu – I’m a risk group person (asthma – the last time I got the flu was so miserable I’m almost flu-phobic now), and I won’t get the vaccine ’til the 3rd of November. Until then, I’m keeping my fingers crossed (hoping noone with the flu comes by the pharmacy where I work)… And well rubbed in ethanol

Good on you for providing correct information to the radio show and all – I’m pretty sure it made a difference to those listening. Most people, after all, will recognise reason and sense, and listen to it
#5 PalMD
October 23, 2009

If the kiddo is still febrile, we probably have to put off the vaccine. If she just has a cold, and they will still let her, we’re going to do it.
#6 CCW
October 23, 2009

They were reporting on a woman who developed a strange neuromuscular disorder and also had received a flu shot.

Surprisingly enough (…) McCarthy et al. are now exploiting the story.
#7 Bad mommy
October 23, 2009

Mine are all getting immunized at school very soon – but stealth is definitely called for. I just mentioned the word “shot,” and my daughter pricked up her ears and reminded me that she does NOT have to have another one until age 11. I may have to have a word with the pedi who promised her that.

I do worry about the risks of the vaccine – the REAL ones – but more about the risks of the flu. I had a serious case as a child and spent three weeks out of school fighting it, pneumonia, and then the weakness and fatigue that followed. I lost 20% of my body weight! Maybe somebody needs to give McCarthy et al a good dose of the flu . . . . .
#8 Shawn Glowacki
October 23, 2009

I would love to read a run down of the discussion about the woman. If its regarding the video clip of the cheerleader who can now only walk backwards since receiving the flu shot, that’s bombarding Facebook right now and I doubt that its meant to be informative.
#9 Mara
October 23, 2009

My daughter and I got the nasal spray vaccine yesterday and I just hope we’re in time. She’s got at *least* 4 classmates (out of 15) out sick with high fevers and one of her teachers too. Too bad we have to wait another month before we get her the next shot.

Do we have any idea how much protection (if any) kids under 10 get from the first shot?

I’m proud to say that I’ve convinced a bunch of my daughter’s classmate’s parents to vaccinate their kids. Go me!
#10 JustaTech
October 23, 2009

Pal, you mean you don’t apply the ole 4-burly-nurses method for giving kids their shots? No one ever used it on me, but man, they needed half the office for my brother. (Me, I was out in the waiting room lying through my teeth to the other kids.) And we never got ice cream! (Stickers. Bah!)
#11 katydid13
October 23, 2009

There is a DC area woman who came down with some rare neuralogical condition after getting a flu shot. She’s all over YouTube. I’ve seen her on the news, along with the PR flacks from a couple of the local hospitals and assorted public health experts. There seems to be some truth to her claims, because I haven’t seen anyone dismiss it. However, they all point out that its an extremely rare reaction and you should still get your flu shot.

It is tragic and of course she says now that she would rather have had the flu. No matter how you get it being struck with a nasty disease that impairs your daily life is tragic.

This of course is stellar example of how people mis-estimate risk. I haven’t done the math, but I’d bet getting in a serious car accident is a far bigger risk than rare serious reaction. People would think you were nuts if you suggested avoiding cars.
#12 CCW
October 23, 2009

From what I’ve seen, there’s no evidence for causality and she apparently got flu days after receiving the shot. Yet, funnily enough, no one’s attributing the dystonia to flu.
#13 Geoff Plourde
October 24, 2009

Doctor,

I respect your position on flu shots and agree that they are a necessary risk for certain groups. However, i believe that much of the concern about swine flu is irrational and unnecessary. This flu is no different than the many strains that pop up every year. I therefore view much of the vaccination effort as a waste of time and resources.
#14 dr. luba
October 24, 2009

Geoff,

It may not be that big a deal for you (being a healthy adult male), but for children, people with chronic diseases and pregnant women this flu has been a killer.

Vaccination works not by simply protecting the vaccinated individual, but by providing “herd” immunity to the community at large. I take my shots so my nephew (young and immunocompromised) and my patients (pregnant women) are protected. And someday their immunizations will protect me.
#15 notgonnaleavemyhandle
October 25, 2009

I’ve gotten my seasonal shot, but am frustrated by the wait for the h1n1. I’m preg and live less than 200 miles from the CDC. The live vaccine has been available here for some time, but not the shot. What is up? I am ready and willing to get this vaccine, so when can I get it?? (Just sounding off here, you’re guess is likely as good as mine…)

I am curious about the preg-related h1n1 deaths. How far along were these women? Is the likelihood of severe complications from the flu the same throughout pregnancy?
#16 PalMD
October 25, 2009

That would be great to know, but the absolute number of deaths is pretty low, so i don’t know how useful the data will be.
#17 Calli Arcale
October 26, 2009

“However, i believe that much of the concern about swine flu is irrational and unnecessary. This flu is no different than the many strains that pop up every year.”

Actually, this flu is different from seasonal influenza. For one thing, we shouldn’t be into flu season yet, and most of the cases that actually got tested so far have been the 2009 H1N1, not the more typical strains. That may just be a testament to the fact that this is new to people’s immune systems, but the pattern of morbidity and mortality seems different from most seasonal flu strains. More people have needed vents, some have been so far gone they’ve needed ECMO (more so than usual) and this is all happening before the flu season really kicks in.

It’s not time to panic yet, but this is the right time to vaccinate. If you’re going to vaccinate, and you want it to be effective, you really need to do it *before* the pandemic strikes. That’s the catch-22 of vaccination — you can’t wait and see how bad it is before vaccinating, because by the time you know, it’s too late.

So I agree that we don’t need to panic, but I disagree that this flu is no different. It *is* different, enough so that people have very little natural protection against it (except older folks, who may have been exposed to a similar strain decades ago).

OT: the term “swine flu” is amusing, since until now, it hasn’t been found in any pigs. I say “until now” because now it *has* been found in a show pig that appeared at the Minnesota State Fair last September. (When the 4H program was cancelled due to H1N1. Coincidence? Probably not; officials believe the pig contracted the virus from human fairgoers or 4H students. The pig actually got sick during the fair, but samples weren’t done testing until now. I’m not sure why it took so long, but it probably has something to do with the vagaries of livestock epidemiology. There’s no livestock H1N1 vaccine, of course; humans have dibs on the antigen for now.)
#18 Leah Daziens
October 26, 2009

I wish someone would find out more details about the “dystonia” woman. She is in our local area, and I was not impressed by the news story showing her SAYING the Johns Hopkins doctors agreed that her condition was caused by the seasonal flu shot, but I have not seen comments directly from any medical professionals. Okay, I found this…
http://www.wcnc.com/news/local/stories/wcnc-102009-al-flu_shot_reaction.23588ced8.html

“We asked Dr. Iyer, can you really get Dystonia from a flu shot?
“I have not come across any link between a flu shot and Dystonia,” he said.

He added, “There’s nothing to suggest that this is a common thing. There’s nothing to suggest that you shouldn’t get a flu shot because most of the evidence supports the fact that it is good and people should get it.”