I think everyone is getting fed up with this 'swine flu' pandemic ! Whenever I even see it on a news website now I just do not want to read about it and I just want to avoid it! For GPs I must admit it is hard work. Guidelines change every single day and there is a lot of confusion in terms of managing this pandemic. People are treated blindly with a drug that is not really effective but is just a drug that has been stockpiled for some reason. It makes you wonder whether the pharmaceutical companies have a say in this or are they the ones spreading the bug to increase their profits? That sounds a bit like a 'conspiracy' theory but anything is possible in this 'messed up' world! We all agree it is a pandemic but it is flu and flu happens every year, it is nothing new. Most people do not die from the flu but from the complications the bug might cause such as pneumonia which can be fatal in some people. So should we even thinking about diagnosing swine flu or is it a 'red herring' in most cases distracting us from other possible diagnoses that could present in a similar way?
Now that is a scary thought! A little girl was taken to A&E with flu-like symptoms so she was prescribed Tamiflu. However, she deteriorated and seemed that she had lower lobe pneumonia in the end but nobody bothered to scan her in A&E so she got discharged home with no treatment for it! This girl should have been diagnosed with pneumonia initially and getting treatment for it in hospital rather than being discharged on Tamiflu! How ridiculous is that?
It was funny when one of the GP's today at the surgery called it 'piggie flu'! I wonder if all the different forms of flu that are evolving will be named after an animal. I cant wait for 'kitty' or 'doggy' flu to come along! It is a bit like having a name for each new year like the Chinese do- is this the year of the pig then?? How exciting! If it is the year of the pig then I think we all ought to get the flu to be trendy ! Another ridiculous thing are the 'swine flu' parties! People try to get each other infected ! Honestly if people think that spreading the swine flu is a way to make friends I think they got it totally wrong. However, the guidelines suggest that the person with swine flu should not be going to pharmacy but should have a 'flu buddy' who will go get the prescription for them! How ridiculous is that! Then their 'flu buddy' obviously will get it from them as they need to go and physically give them their Tamiflu!
Oh enough on 'piggie' flu and Tamiflu! Why do they even call it flu? Sounds a bit like 'loo'!! Anyways, let's not swine flu rule our lives. Another important learning point for me today was a lady who came into the surgery with 'restless leg syndrome'. This was something I had seen before as a side effect to antipsychotic medication. However, in this lady it was not initially drug induced, which suggested it being idiopathic. As a result, she was treated with anti-parkinsons drugs such as pramipexole. However, it seemed that drug was giving her even more side effects as she was getting involuntary movements around her abdomen and her eyes as well. So she had to stop that and move onto another medication such as clonazepam or an anti-epileptic such as gabapentin.
I did not even know that this syndrome existed and some people have it for life which can be very hard to deal with. It uses up so much for your energy and not being able to cure and having to be on medication all the time makes it a really frustrating condition!
Another important lesson today was one about 'oculogyric crisis' . No it is not all Greek to you, it is just a medical term for someone who presents with incredible restlessness, agitation, malaise, or a fixed stare. Then comes the more characteristically described extreme and sustained upward deviation of the eyes. In addition, the eyes may converge, deviate upward and laterally, or deviate downward. The most frequently reported associated findings are backwards and lateral flexion of the neck, widely opened mouth, tongue protrusion, and ocular pain. However it may also be associated with intensely painful jaw spasm which may result in the breaking of a tooth.
Most often apparently this happens on surgical wards post-op after the patient had stemetil or metoclopramide as an anti-sickness tablet. This tablets have a lot of side effects and can cause this 'oculogyric crisis' . The presentation can be rather upsetting for the houseman that has not seen it before. It can even lead to a psychiatric referral. However, all they need is to be given procyclidine, which is the antidote and can totally reverse the effects. It is effective in 5 minutes but in some people it can take up to 20 minutes to half and hour.
Lastly, another patient I saw today had a biceps muscle rupture. This was something I had never seen before and apparently it gives you 'popey's arms' ! I just love it in medicine that we use all these little tricks to remember things. It makes everything sound very entertaining!
So from 'piggie flu' to 'poppey arms' the world of medicine never stops to startle and excite me as well as entertain me! It is a definitely incredible world ! Hurray!
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