hpr-knowledge-base/hpr_transcripts/hpr0622.txt

Episode: 622
Title: HPR0622: Influenza
Source: https://hub.hackerpublicradio.org/ccdn.php?filename=/eps/hpr0622/hpr0622.mp3
Transcribed: 2025-10-08 00:01:22

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Hi everybody, today's episode of Hacker Public Radio has been bombed to the top of the queue
because I feel the information and it is something that should be released to people ASAP.
I'd like to send apologies to DWP, Latu and Poki who have had shows ahead of today's show.
Hey everyone, this is Jane Doc, I'm recording an episode today
about influenza. Influenza is a timely topic this time of year. It's December, we're around the
Christmas holiday and it's also the winter time in the United States and this is the time of year
where we see a lot of influenza cases. Before I get into the flu, I wanted to give an update
from my previous episode that I recorded. That was an episode about electronic medical records.
I am still in private practice, I am a medical doctor, I'm in private practice and about a year
and a half ago I was really researching this whole EMR idea enthusiastically and we haven't
bought EMR system in our office. For one thing, my senior partner just refuses to do anything
electronic. She won't even do electronic prescribing which the rest of us do but also it remains
kind of costly. We would have to put up quite a bit of money to get a system going. A year and a
half ago I estimated it would cost roughly $300,000 to get a system in place for my practice.
I'm not sure it would be quite that much anymore. At the time we had six providers and I was
estimating about $50 or $60,000 per provider averaging about $300,000. It would probably be more
in the range of $150,000 for an office my size but that does not include the loss of productivity
as we learn how to use this electronic medical record system when you're spending so much time
trying to get things filled out on the computer. It means that you can't see as many patients and if
you can't see as many patients your income goes down. There's a lot to the economic reasons for
getting electronic medical record. In the past year and a half the powers that be have been
establishing what it means to have meaningful use and what it means for an electronic medical
record system to be certified. I'm talking about the United States in this regards the stimulus
package that was passed early in 2009 to repay doctors for getting an EMR system up in their office.
Right now a physician, a primary care physician like me can be reimbursed up to $65,000
to put in an electronic medical record system. The thinking was that this would help spur more
primary care doctors to get EMRs in their office but that is a reimbursement and it would be a
reimbursement over like two or three years and we just don't really have the money to get a
system in place so it hasn't really happened. In the meantime my office will probably be transitioning
from private practice to being employed physicians so we will work for the local community hospital
and which is owned by a national corporation. The national corporation I have electronic
medical records and all of its outpatient clinics now and I believe they use Athena Health.
I've not really looked at Athena Health but if I'm an employee and that's what my boss
wants me to do then that's what I'll do. So let's go on to influenza. Doctors care so much about
influenza because for one thing it causes a lot of people to get sick it causes a lot of morbidity
in addition it causes a lot of people to die it causes a great deal of mortality. In the United
States on average it causes about 36,000 deaths per year. There are higher risk populations that are
more likely to die of influenza those include the elderly. The elderly can't mount a robust immune
response they're just they're just not as strong as children and young adults and also the elderly
tend to be not as strong as young adults and children so they are more likely to get pneumonia
it's harder for them to cough out any obstruction in their airway and it's just much harder for
the elderly. Influenza also hits young children much harder this is something that I'm especially
interested in. If a young infant let's say like a two-week-old little baby gets influenza their
chest isn't quite as strong all of the the tubes and their airways are very narrow and they get
clogged real easily and so small infants are more likely to die of the flu also those with a certain
chronic medical illnesses such as diabetes heart disease neuromuscular disorders such as muscular
dystrophy and cerebral palsy again because they're just not quite as strong and they succumb to
influenza a lot more easily. I want to go over the biology of the flu. This is in more detail than
I usually do for my patients but hacker public radio I'm sure would be interested in this. Influenza
is a virus it is not a bacteria it's a virus it has a lipid outer envelope there are two important
envelope glycoprotein so these are proteins that float around in the envelope hemagglutinin
and neuroaminidase that is the H and N hemagglutinin is especially important to doctors because
our our bodies immune system attacks the hemagglutinin that's how we get our antibody response
and the vaccine also produces that antibody response to the hemagglutinin. There are 15 hemagglutinin
proteins out there and there are nine neuroaminidase and so you might have a different combination
of H and N the one that got everyone's attention in 2009 was the H1N1 flu pandemic and I'll talk
about that a little bit later. Influenza has an RNA genome it has 11 genes on eight RNA segments
and the influenza virus the RNA polymerase lacks a proofreading mechanism so mutations occur
frequently and genetic mutations occur especially frequently on the hemagglutinin
which is why you have to get a new flu shot every single year. When influenza attacks a person it
attacks the cells that line the respiratory system the RNA gets into the epithelial cell of the
respiratory tract it is transcribed in the nucleus this causes discrimination of the epithelial
layer and so it kind of produces a lot of goo inside the lungs it's important to be able to cough that
out. Influenza comes in a season when the air is cold and dry because that's the flu virus attacks
the cells more readily then and influenza is very contagious it's one of the more contagious viruses
out there and during the H1N1 epidemic last year there was a lot of emphasis on washing your hands
on if you cough you cover your cough with your sleeve because if you have the flu and you're shedding
virus out of your respiratory system these viral particles actually float in the air it's a small
particle aerosol and so it's very easy to infect other people. The treatment for influenza
there's a couple of ways of looking at the treatment the first is symptomatic care and when doctor
is talking about symptomatic care that means if you have a sore throat then you take ibuprofen or
Tylenol to help the pain of the sore throat if your muscles ache ibuprofen or Tylenol is good for
that too you can get dehydrated very easily when you have the flu so you got to drink lots of fluid
if you're producing a whole bunch of mucus then you just get dried out real easily so you got to
drink lots of fluids it's very important and also just to rest just go to bed your body is
fighting very hard to kill off this virus so just lie down and put all of your energies into
fighting off this virus there are two medicines available these are antivirals specifically they
the inhibit the neuroaminidase they are neuroaminidase inhibitors one is called relenza that's the
brand name the other one is called tamiflu that's the brand name for that as well the trick to
taking tamiflu or relenza is you have to take it really within the first 24 hours of getting
symptoms and I you know one to two days of getting the symptoms if you're on day three or four
of your symptoms and you go to your doctor and you ask for these this is really not going to do
any good plus I have seen tamiflu have some significant gastrointestinal side effects one of my
colleagues had the flu last year before she was able to get the vaccine and she took tamiflu
and she had a lot of nausea she actually had to stop tamiflu supposed to be taken for five days
she took it for like three days she just couldn't handle it so these are not easy medications to take
if you get an overlying bacterial infection on top of your influenza then you would need antibiotics
so if you get bacteria that invade your lungs and you get a pneumonia then you'll have to take
antibiotics for that and what I recommend to people is if if you're a healthy person and you
get the flu symptoms which are first a fever this is a fever greater than 101 typically with
influenza you can get fevers 102 103 or even 104 and this is Fahrenheit you get a huge amount
of nasal congestion and mucus production in your nose and so you're blowing your nose a lot
you get a cough that influenza attacks the cells of your respiratory system and you got to cough that
stuff out cough suppressants you can take those if it makes you feel better but you really don't
want to get yourself too doped up because you need that cough to get that stuff out of your lungs
what sets influenza apart from your standard respiratory viruses is how bad it makes you feel you
just feel terrible you can't do anything you can't even get out of bed I had the last time I had
the flu was when I was in interns about 10 years ago and it was my intern year I was working hard
I was in the children's hospital I had my face in many many ill children and even though I got the
flu shot that year I still came down with the flu or I'm assuming it was it was the flu I never
actually confirmed it but I was in bed for four days I had fever I had muscle aches I had a
horrible cough and it was terrible and I really didn't recover for two or three weeks it really
takes a lot out of you and for most people who get the flu I mean most listeners of Hacker
Public Radio are young healthy adults if you get the flu you're not going to die I mean more
likely than not but you lose a week of your life that's a week that you really can't do anything
else because you're too sick so influenza is something that you should take seriously I take it
very very seriously so at this point let's talk about the flu virus or the flu vaccine and there
are two types of vaccine one is the injectable vaccine and the other is a nasal mist it's called
flu mist because influenza changes so frequently a different vaccine has to be developed every year
the way that I understand this now I'm not an infectious disease expert and I am not especially
a virology expert I'm not a virologist but from what I understand there are experts at the
World Health Organization the Centers for Disease Control Prevention here in the United States
and other groups around the world and they meet and they have to decide which of the three strains
are going to be put in this year's flu vaccine this is usually done about in March they have to
look at what the flu is doing in Asia because usually the flu starts in Asia they choose two
influenza A strains and one influenza B strain what happened last year was that the three influenza
strains were decided in March and then in April H1N1 came out and this was something totally new
and unexpected and so in addition to the regular flu vaccine that was being produced they had to
hurry up and get the H1N1 vaccine out as well because they knew that a lot of people would get sick
from H1N1 it was actually very scary at the beginning of the 2009 flu season we really didn't know
what was going to happen every doctor learns about the 1918 influenza pandemic which killed
many millions of people around the world and we just didn't know if H1N1 would be on that
scale where every family in the United States would have someone become very very ill or even die
from this from this virus as it turns out H1N1 was not as bad as a lot of us had feared
we did have a lot of sick people but in my clinic we had very few hospitalizations from it and none of
my patients died from it so we really dodged a bullet there we really got lucky and H1N1 really wasn't
as bad as we had thought and the H1N1 vaccine actually worked quite well to produce the influenza
vaccine this is an old old technology it was developed in the 1940s it was developed by the US
military and it involves injecting the virus into chicken eggs and then they develop the the vaccine
from that so really rudimentary old-fashioned vaccine technology there just really hasn't been a
reason to change the the technology until last year the trouble with using eggs is it takes about
six months to make the vaccine and when H1N1 came out that vaccine took about six months and
so it slowed the process down quite a bit
the flu vaccine is the main way to prevent getting in influenza it is very effective
and you cannot get sick from the flu vaccine I'm going to say this again you cannot get sick
from the flu vaccine particularly the injectable form the flu shot is a killed virus vaccine you do
not get the flu from the flu shot the nasal spray is a live virus vaccine so there is a theoretical
risk of getting some flu symptoms from the flu mist however I've never really seen it happen
this isn't something that's that occurs a lot so don't I don't want anybody to be afraid of
getting the flu vaccine it might make your arm a little bit sore and that's usually about the
worst of it the the main way to prevent mortality to prevent deaths from influenza is to vaccinate
children the reason is that children transmit this virus kids are just everywhere they're always
infecting each other and they're going to infect the adult that they're around so if you have an
elderly grandmother who visits your home more more than likely that elderly grandmother is going to
get the flu virus from their grandchild it is recommended that the elderly get the flu vaccine however
the elderly really don't have a very robust immune system and so they don't respond very well
to the flu shot it's still a good idea to get but if you really want to protect the your elderly
loved ones get all the kids around you vaccinated because vaccines work a lot better in little kids
the flu mist you have to be a healthy person you're not supposed to have any kind of chronic
medical diseases like asthma or you know heart disease you have to be at least two years old
to get it and you can't be older than 50 years old those those are the rules and what I have found
is that little kids like two and three year olds they really don't like getting the flu mist they
it really scares them getting this syringe injected into their nose they find it very unpleasant
for so for little kids two and three year olds you might want to just give them the shot because
it's frankly just easier to hold their leg and give them the shot that's been my personal experience
I have myself taken the flu mist for about the past four or five years since it came out
and I haven't had influenza even with H1N1 I didn't catch H1N1 and part of that is probably
luck but I think a lot of that is because I'm pretty good about getting the flu vaccine every year
it is covered with most insurance most insurance will pay for you will rather pay for the vaccine
if you get it then even if it doesn't and you can't get it for free like at your employer
it costs about twenty five dollars if you go to Walgreens or Walmarts about twenty five bucks and
I think that's a small price to pay to avoid getting the flu so to sum it up
influenza it's a very serious disease and it can kill you so take it seriously don't ever turn
your back on it and don't take it lightly get yourself vaccinated get the flu vaccine that's the
best way to protect yourself against the flu and if you do catch the flu despite all that
stay home don't get out and transmit it to other people go to bed drink lots of fluids take your
motrin and you should be fine so stay healthy everyone have a happy holidays and until next time
this is Jane Dock
thank you for listening to HACRA Public Radio
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