About 2 weeks ago a gentleman from Sydney visited Denver. He had left Sydney over a week earlier, spent time in Peru – where he gathered some mosquito bites – and arrived in Denver where he developed fever, shaking chills, and severe myalgias. He did have a bit of a cough, though not as a prominent part of his symptoms. His pathology reports were pretty unremarkable except mild thrombocytopenia, and though he did not have the characteristic ocular pain, I thought he probably had dengue, recommended that he use some paracetamol, and HTFU.
Explore This IssueACEP News: Vol 31 – No 09 – September 2012
A few days later when I developed some myalgias, I thought nothing of it, but the shaking chills, drenching sweats, and progressively worsening fever and myalgias got more of my attention the following day, and I contemplated a journal article on the person-to-person transmission of dengue fever – thus bypassing the lowly mosquito. Another day on, when every fourth breath was followed by a painful paroxysm of sputum-producing cough, I rethought that prospect, and – being a highly trained emergency physician, skilled self-diagnostician, and having broken slightly fewer than 20 bicycling helmets in my career – made a connection. Although we rarely think of influenza during the Colorado summer, this gentleman came from Sydney. I further recalled that it was winter – either on the other side of the date line or the other side of the equator – since Sydney was on the other side of both, I didn’t bother to Google which. However I did check on Google Flu Trends (if you haven’t checked it out as a useful website, do so – though Tasmanians will note that Tasmania appears to be grouped with Antarctica as being unimportant flu-wise (it also seems unusual to “Google” “Google flu trends” to get to the site, but it works) and found that indeed Australia is having a lot of influenza.
So, having suffered through one shift with myalgias only, I thought that perhaps taking some oseltamivir ($100 for 1 day less of suffering is a bargain to me) and skipping my next ED shift might be good for me and my patients.
One note to my Aussie friends: American attending (consultant) physicians work night shifts along with our residents, so last Thursday night when I was scheduled to work 11 p.m. to 8 a.m., I decided that I really couldn’t HTFU to work all night and called a fellow faculty member, Dr. Comilla Sasson, who worked my shift for me.