Annals of Medicine: What’s Going Around?

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By Robert C. Reiser, MD

What’s going around? It’s a question my wife asks me every week, every Monday to be exact. By virtue of my constant exposure to the current diseases of the community I feel well qualified to answer this question confidently and I always rise to the bait.

“Croup.”

“Nope.”

I think a little harder.

“Gastroenteritis?”

“Wrong!”

I always seem to get it wrong, at least according to my wife and the local Monday news feature “What’s Going Around?”

For example, I did not realize hip fractures could be contagious, but that was what going around some months ago, according to a local orthopedic doctor.  Sure enough, I saw several hip fractures that week.

Another local doctor is seeing a lot of nasal irritation. Yup, I got that one wrong too. I looked for it all week but didn’t see any cases. To be fair, I didn’t look very hard.

I am getting better at this, though, after several years of guessing. Seasonal allergies are always a safe bet, they seem to be going around no matter what time of year it is. Viral infections are the other consistent winner of What’s Going Around, which I don’t find to be very useful news as a patient but certainly it is helpful when trying to confidently explain unexplainable symptoms to my patients.

“It’s a virus, they are going around right now. It was in the news.”

In the Emergency Department we do see characteristic patterns of disease depending on the season. Last week I saw four kids with croup during a single overnight shift. Croup is a viral infection of the lower throat that affects young children beginning at this time of year and causes a very distinctive cough that has been described as sounding like a seal barking. It is usually worse at night, which is when we see most of the cases. In addition to this barking cough, the inflammation of the lower throat can very occasionally cause these kids to develop pretty severe respiratory distress. It is quite frightening to the parents and with good reason. The kids are breathing 40-60 times a minute, nostrils flaring, every breath a noisy labored inhalation, the muscles of the neck and between the ribs tugging inward with each breath. They sit bolt upright, refusing to lie down.

One of the most effective treatments for this degree of inflammation is simply cool moist airflow and often by the time the kids get to the ER the exposure to the cool, moist night air of fall during the car ride in has significantly improved them. The relief of the parents is palpable and their gratitude toward the ER staff for any ancillary treatment buoys the spirits of my middle-of-the-night staff. We watch these kids carefully and usually administer a one-time dose of a high potency steroid to further calm the inflammation. Most go home after a period of observation.

The fall season brings characteristic injuries in to the ER as well. Wood splitters, gasoline-powered wedge rams for splitting logs into firewood, maul several patients’ hands every fall. I still don’t understand how this happens. The wedge moves very slowly, 1-2 miles an hour over a distance of 2-3 feet. But it happens.

Hunting season opens in the fall and aside from the rare accidental gunshot wound, we also more commonly see falls out of tree stands and heart attacks from trudging around the woods.

And of course like winter, the flu is always just around the corner. Get your flu shot! So that is what is going around this week, honey: heart attacks, falls, mangled hands, croup, flu shots. It is in the news.