Swine Flu- An Historical Perspective

Most folks have heard that the Spanish Flu pandemic at the close of World War I killed millions of people, and was a shocking illness that left memories of it for generations afterwards. This is certainly true.

However, in the context of the current early stages of this influenza outbreak, it is useful to look back at the Big One in a more statistical light.

As many as 2.5% of people who got the flu died.

This does not mean that 2.5% of the world's people died, it means that 2.5% of those who got the flu died.

In fact, only 28% of the world's entire population got the flu at all. 97.5% of them survived.

In other words, in the world's worst flu pandemic in history to date your odds of not getting the flu at all were 7 out of 10, and if you did get it your chances of survival were better than 9 to 1.

And this was before advanced emergency medical care, advanced hospital care and before antiviral and antibiotic medicines.

Swine Flu

DO NOT PANIC, PLEASE!

Swine flu is a flu virus (Type A H1N1) which has been identified in Mexico where it caused 20 deaths, and also in the US, Canada, and possibly New Zealand and Spain where it has caused no deaths.

The reason that the federal government declared a national public health emergency in the face of a new strain of flu is to be able to rapidly move flu medicines from a national stockpile to places it is needed as quickly as possible.

With the exceptions of the deaths in Mexico, Swine Flu is like having the flu: fever, aches, congestion, cough and sometimes vomiting and diarrhea.

It should be treated like the flu:

• stay home
• cover your mouth when you cough or sneeze, discard the tissues in the gargage.
• use Tylenol for fever or aches
• use medicines such as Coracedin, NyQuil or Robitussin DM for cough and congestion
• use Benadryl for nausea or vomiting
• use Imodium/AD for diarrhea

Seeking emergency medical attention is reasonable for unusual symptoms such as:

• chest pain
• difficulty breathing
• unremitting vomiting

To avoid getting the flu,

• Wash your hands frequently with regular soap or waterless hand cleaner.
• Avoid touching your eyes, nose or mouth.
• Avoid visiting ill people, if possible.
• Consider using an N95 respirator mask. These filter out viruses and bacteria from the air you breathe, and can be bought at hardware stores where they are used for sawing and grinding work. These are fiber and semi-disposable, not the big rubber ones with large filter cartridges!

Hearing Aids

Hearing aids, technology and the Baby Boom have finally come together in a "perfect storm" with the happy outcome of really good hearing aids for not much more than the older funkier ones.

The technology around small audio devices, high fidelity, good micro-circuits and batteries has been around for a few years, but the demand has not. Not until recently, that is. With the Baby Boomers finally hitting AARP and MediCare age, there are millions of potential customers for hearing aids that "ain't your fathers hearing aids".

Especially for folks with the most common kind of high-tone hearing loss (more loss at pitches around human speech than at lower pitches), the newer "open-ear" devices are a perfect fit. They are nearly invisible, work well, and don't squeal with feedback even when you use a phone, wear ear protectors, or use a helmet or a hat.

These often cost around $4,000 a pair which is not much above the older clunkier ones. MediCare may cover up to about $500 of this. Make sure the vendor has a reputation for seeing you after the sale for any further fittings and fine adjustments.

I am very impressed that I have had several patients in the past few months absolutely ecstatic over their new hearing aids and the quality of service from their vendors. In fifteen years, I have never heard anyone go on about how happy they were with their hearing aids!

The patients in question had obtained them at All American Hearing in Cameron Park, and the Costco in Folsom. As a disclaimer, I have absolutely no financial ties to either organization and receive no compensation or "kick-backs" from them. (I am, however, a Costco member and am impressed by the quality of the meat and produce selections.)

I have heard every objection to getting hearing aids that there is. Think about it in the same way you would think about LASIK vision correction or a remodel on your home. If the money involved would be worth it in terms of quality (hearing really, really well in this case), then the time to spend that money is when you will be able to enjoy it for a long time. This may also mean while you are still relatively young and still working, since you are still bringing in a paycheck. This is easier than after you retire and are living on a fixed income, and certainly better than waiting until you are so old that you may not get to enjoy them for long.

Hearing what's going on around you, not feeling irritated by having to ask people to repeat themselves and being able to fully enjoy a conversation, a party, music or a dance are not at all over-rated!

EMR- Electronic Medical Records

20%
Percentage of doctor
offices using EMR


70%
Percentage of doctor offices dropping EMR
within 2 years of buying one


$65 Billion
Amount of money
being budgeted
towards national
implementation of EMR

I guess I'm not too hot on the concept of electronic medical records.

As a preamble, let me say that I own several computers, have installed my own wireless networks, enjoy using computers, have tried voice recognition software, and have beta-tested several EMR systems.

Bottom line, they do not save me time or make me more money. In fact, they can cost up to $40,000 to implement and take me longer to document what I do. They do not pay for themselves, and they do not help me to render better medical care than simply keeping and paying attention to a well-organized paper record. Plus, the paper record can still be used even if the power goes out, or the scheduling computer doesn't work.

I also note, that the EMR produced notes from many of my specialist colleagues that are often up to 4-5 pages of not much more useful information than I can get out of one page of well-organized well-written manuscripted notes.

As EMR systems become for comprehensive, they can actually start to make the job harder: for example, not permitting me to list a strong family history of breast cancer on the master Problem List. Like many other features of medical care, a system created by non-doctors and non-nurses may not be particularly effective or easy to use by doctors and nurses.

Also, there is no agreed upon code standards, so none of these expensive systems is capable of interfacing with other systems.

Believe me, I would enthusiastically embrace a system that allowed me to do my work faster, better and more efficiently that was affordable and as universally used as Microsoft Windows. I doesn't yet exist.

Sleeping Pills

A word about sleeping and sleeping pills.

Ambien was a hot new drug for sleep back in the early 1990's, and went generic as zolipedem in the last year or so. If you watch TV or read magazines you would have noticed because you have been blitzed with ads for the competion: Ambien CR, Lunesta, Sonata and Rozerem all sound like the greatest thing since sliced bread. At least, they do on TV.

Granted, older sedatives often taken for sleep (such as Valium, Ativan, Restoril, Serax, etc.) create problems because they render you unconscious, not asleep. This is crucially different, since you are losing up to half of the really deep, restorative sleep and dream sleep when you take these. When this happens for over three nights in a row, daytime problems will follow; such as forgetfulness, irritability, tiredness, depression, moodiness or difficulty concentrating.

When Ambien first came out, it seemed to be the best of both worlds: helping people to sleep, but without the loss of deep sleep and dream sleep.

Unfortunately, it may be that Ambien and the other newer sleeping pills may not help you sleep any better, they may just keep you from remembering your sleep. This may be why some people who take it have been seen to cook, eat or even drive at night without remembering doing so.

Basically, people get needed sleep. Insomnia is often a symptom of another problem such as stress, depression, sleep apnea, pain,urinary problems, drinking or long-established bad sleep habits. The treatment then is to treat the underlying problem, not to be drugged into unconsciousness every night.

To make it easier to sleep well,

• Go to bed and get up at the same time every day, including weekends, vacations and holidays.
• Don't eat or have alcohol or exercise within two hours of bedtime.
• Don't watch TV in your bedroom.
• If you can't sleep, go to another room and read or listen to some music. Do not watch TV or use your computer! The light from the screens stimulates your brain and wakes you up.
• Try taking 2-3 mg of over-the-counter melatonin about 1-2 hours before your bedtime.
• Tylenol PM is OK to use for sleep, unless you find that it causes side-effects or makes you feel groggy in the morning.