Tuesday, March 20, 2007

Bird Flu

To cope with our dramatic undersupply of patients (I use the plural, but at the moment we have two elderly airways disease patients who are both sitting comfortably), our new consultant has instigated a series of surprise tutorials. He does this by pouncing upon anyone looking idle (or even anyone working) and saying "Why don't you look up a recent evidence based article on the management of hepatorenal syndrome and then come and tell me about it in half an hour?".

The answer "because I don't want to" is not considered adequate.

I was asked to give a talk on the diffuse parenchymal lung diseases. The gist of my talk is as follows:

If you get diffuse parenchymal lung disease, it could be caused by any of two hundred causes - from tuberculosis to budgerigars.

Most of the time no-one knows what is causing yours - the so-called 'cryptogenic" causes.

A lot of time we tend to give you steroids and stuff, no-one really knows if this works or not, but it seems better than doing nothing.

Even if it does work, you won't last long and you'll be increasingly sick for the rest of your (often brief) life.

While this is not exactly true, it's not entirely untrue either. The other talk was on our bird flu plan. Basically, the hospital has a plan for if bird flu jumps species to humans as a highly contagious, highly lethal influenza. The gist of the plan seemed to be that initially we would look at containment and subsequently we would look at maintaining essential services. This would be difficult, our consultant warned us, with as many as six hundred and fifty deaths among hospital staff alone, and an ICU that could handle perhaps four to six of the seriously sick people.

There was no place in the official plan for running screaming into the desert.

However, we are all being fitted for special breathing masks, so that come the plague, we can all move amongst the piles of dead with minimal risk of infection. The woman fitting the mask apparently advises us not to smile too much as this may compromise the seal. Somehow, I don't think this will be a problem - the real issue should be whether the masks still fit over a rictus of horror.

Anyway, off to read up on pulmonary emboli - which I will be talking about in thirty minutes.

Thanks for listening,


Blogger Foilwoman said...

Could you possibly look into recent literature about chronic (or at least recurring three times) uvulitis in cranky middle-aged women in the Atlantic Seaboard region of the U.S. and why this annoying disease keeps plaguing at least one woman who has done nothing whatsover to deserve such an annoying afflication, which would be much better utilized in cutting off Dubya or Dick Cheney's airway? And, of course, tell me about it in half an hour.

And what's with the budgerigar motif here. I've got nothing against budgerigars, mind. Some of my best friends are budgerigars, or have the personalities and IQs of budgerigars.

2:41 PM  
Blogger Benedict 16th said...

1) The answer is always Sarcoid - "diffuse parenchymal lung diseases", too bad I have only ever seen one confirmed case.
2) in 2003 all medically registered doctors in Oz received one Category 3 mask to help with the SARS contagion, one problem, the masks worked really well as long as you didn't have facial hair and didn't breathe, apparently 15 minutes of normal respiration made the nano-filter paper too moist and shrunk the holes so that either you couldn't breath (and at least not spread SARS) of you breathed and punctured larger holes so that it could spread the airborne virus.
3) Quincke's disease
Uvula Edema

One (obvious) trigger is the use of antihypertensives of the ACE inhibitor class, or AIIA (Angiotensin II receptor antagonists),

anouther is a not uncommon - strep throat (Group A strep. specifically Haemophilus influenzae or Streptococcus pneumoniae)

Indeed there is an association with OCD/ADHD and Group A Strep called PANDAS, but the actual existance of this is controversial, although I have one teenage patient with ODD more than ADD, who's parents are convinced any increase in symptoms are due to strep. throat and usually receive POP (plain old Penicillin - phenoxymethylpenicillin) - maybe you should ask Prom more about that.

My suggestion - if your insurance covers it, get your doctor to do a allergen specific set of RAST blood tests - for IgE and subtypes (Normally a skin prick or scratch allergy test is done looking for IgE mediated allergies - but the blood test will better pick up the reaction to squamous mucosal tissue). As well as a protein electrophoresis (looking at immune proteins IgG, IgM, IgA and IgE) looking for (eg alpha-subunit heavy chain immunocomplexes that are present in heavy physiological stress reactions (think amphetamines, a psychotic ex, 2 gorgeous but hard work dependents and a full time job). And maybe a ASOT test - if the ED doctors didn't already do that, or another more specific test for post infection.


4:55 PM  
Anonymous Anonymous said...

Benny - they didn't give those priceless masks to all Oz docs - they left out those on maternity leave (and probably plenty of others too)

BJ - I thought all doc's had those crises of confidence and certainties they are not cut out for what they are doing.... I also think that those are the people who should be doing it, they are the ones who care...

glad you are back and hope ICU suits, for a while (but not too long!)

Mum of Claire & Em

10:58 PM  

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