Flu Update

We started doing more flu tests; today 5 tested positive for type A and 3 positive for type B flu.  A few comments:

(1) Flu vaccine efficacy: we had 2 positive tests so far in children who got injectable (Fluzone) flu shots; in both the disease was mild and went away quickly.  We have had NO flu at all so far in children who got the nasal Flumist vaccine.  Remember, injectable flu is shot still the only one recommended for ages under 2, over 49, and for high-risk individuals.
(2) CDC reports that most Flu A strains this season are resistant to treatment with Tamiflu, our usual drug of choice.  We tried to prescribe Relenza, to which the strains are sensitive, but ran up against the fact that none of the local insurers cover this medications.  I guess no one at the insurance companies reads  www.cdc.gov/flu/weekly

(3) One of the children who tested positive for flu simultaneously tested positive for Group A Strep.  Both infections are running around schools and day care centers, so to have both at the same time would not be unusual; this is just a reminder not to stop looking for answers once you have one good answer: it may not be the only answer…

(4) Having Flu A does not make one immune to B, and vice versa.  It’s not too late to get you flu vaccine, even if you have been sick.


Brain Surgery

Two things happened recently which are in my mind connected:

First, last month a brain MRI I ordered on a young boy showed a very small tumor, highly curable.  The reason this is remarkable is that I ordered an MRI for a headache that was not highly suspicious.  I don’t even think the headache was caused by this tumor, but there it was, quarter inch or so in diameter.  I ordered that MRI and it got done.  It would not have been done in any country that has socialized medicine because none of the factors that indicate a high risk for a tumor were present.  None, except parental concern and my desire to serve my patient to the best of my ability.  I should mention, too, that neither this boy’s parents, nor mine, were born in this country.

Secondly, Dr Sanjay Gupta was announced a few days ago as the new administration’s choice for Surgeon General.  Dr Gupta is (coincidence?) a brain surgeon whose parents were (coincidence?)  not born in this country.

The reason I think this is great is: as a neurosurgeon, Dr Gupta should remember the faces of the patients he saved because a timely MRI was made,  and those he did not becuase the MRI came too late.  The road to a neurosurgical career is far too arduous for anyone to undertake it becuase they like statistics; Dr Gupta had to have done it to see the lives he changed himself.  And I expect him, an Indian-American, to understand why his parents chose to emigrate from a country that had a public health system to one that did not.

As did my parents.

And the boy’s.

I support Dr Gupta’s selection, in part, because  of his great skill in communication.  I expect him to do what public health specialists notoriously do not: trace the effects of proposed initiatives down to the individual patient who will be affected, and communicate these concerns to the American people.   I expect him to know the difference between health care that generates great statistics and health care that works for the individual patient — and I expect him to speak out against people who confuse the two though they should know better.
I applaud Dr Gupta’s selection, not because I think he will preside over a great health care revolution, but because I think he will do to the many insidiously well-meaning revolutionary proposals what he had done to the many insidious brain tumors:

Brain surgery.