What does it mean when someone says they have the “flu”?  This usually means they have a “cold” or upper respiratory infection with runny nose, cough, and maybe a low-grade fever.  Sometimes people say they have the “stomach flu”, and this usually means that they have an intestinal virus causing nausea and/or diarrhea.  However, to healthcare workers, “flu” refers to illness caused by one of two specific viruses – Influenza A or Influenza B.

 

Influenza A and B viruses cause widespread infections called epidemics each fall and winter in the United States.  5-20% of people will get the flu each year (as many as one in five) – more than 200,000 people each year.  Unfortunately, there is as many as 36,000 who die each year, including thousands of children.  The elderly, children, and many with chronic health conditions such as asthma, diabetes, and heart disease, are at particular risk of serious complications.  The tragedy is that most of these deaths can easily be prevented.

 

Symptoms of the flu are many and can include high fever, headache, sore throat, extreme tiredness, runny nose, dry cough, muscle aches, and sometimes vomiting and diarrhea.  Complications can include pneumonia, sinusitis, ear infections, dehydration and worsening of the chronic conditions mentioned above.

 

You can get the flu by touching something infected by another’s cough or sneeze, and then touching your nose or mouth.  It’s possible to spread the flu up to one day before you even feel sick yourself!

 

You can easily dramatically reduce your chances of getting this deadly disease by getting a flu shot (or the inhaled version called FluMist).  The flu shot is approved for almost anyone over 6 months of age, and is recommended for healthy people as well as those with chronic medical conditions.  There are only a few people who should not receive the flu shot – Be sure to ask your primary care provider if it’s OK for you to get a flu shot.  (The shot form is even OK during pregnancy!)

 

Don’t let it be open season on you!  Wash your hands frequently, cover your sneeze and cough, and ask your primary care provider about a flu vaccine!  Flu vaccinations are available now, but can be very helpful as late as December and January.  Don’t wait to protect yourself!

John W. Fleming, PhD, MD, FAAFP
Assistant Director

 

 

 

 

When I was nearing the end of my third year as a medical student I spent a month in Kingman, Arizona for a rural family medicine rotation.This was “full spectrum” family medicine with more OB than most formal rotations. I liked the responsibility, had a call pager, would come in to the hospital at all hours of the night for deliveries. Usually beating my preceptors there. Disconcerting, sitting gowned and gloved in front of a crowning baby inching its way to the first cry. Once I made the mistake to ask the nurse if the attending had showed up yet. I was so nervous it would just be us in the delivery room. She went to check–then it was just me, mom, and and an imminent birthday party.

One of the scariest moments, however, was over before I could fully appreciate the seriousness of the situation. I was delivering yet another baby in the wee hours of the morning when awkwardly, the baby stopped in mid-delivery. The preceptor, usually sleepily coaching, sparked to life. In a flash he was angling and maneuvering the baby and the mother’s legs. The baby came out normally after that, it seemed to me. “That was shoulder dystocia!” he exclaimed in unfamiliar exasperation. The baby was positioned with the shoulder pinned behind the mother’s pubic bone and would not budge. Life threatening to mother and baby, knowing what to do in this situation is essential.

This and other nightmare scenarios were drilled into us for two days at The ALSO course for high risk obstetrics. As FM interns we have two months of OB and our continuity patients to care for as well so the training was much appreciated.

The lectures were presented at a fast pace at the beautiful Valle Vista country club, with its spacious lecture halls and home to an impressive golf course. While this was unexpected, the atmosphere was reminiscent of the floor (where the hospital transforms into a cozy, floral environment). Another pleasant surprise was that most of the FM residencies in Indianapolis and one from Terra Haute (with my AZCOM classmate as a new intern) all attended the training together. Everyone got along very well, especially over the lunch break. I haven't laughed so hard in a very long time - thanks to Chris, Anna, Katie, Laura, Rachel, Kelly, Adrian, and Amy. Not only did we get the firsthand experience of the Community attendings, but the attendings from the other programs as well. It was an impressive bunch.

Along with the lectures, we had numerous workshops including forceps training, vacuum extraction, post partum bleeding, shoulder dystocia (remember suprapubic pressure), and laceration repair training on real cow tongues!All of this increased my comfort level with OB, and I will definitely still keep the “phone book” handy. The culmination of the course is the “Mega delivery” where we apply everything we learned during one unfortunate scenario on a plastic mom and baby model. Everything that can go wrong does. Before the exam, the halls were filled with studious residents reviewing their notes.

I’m grateful for running through it all on models – it was stressful and tense situation where seconds count. The entire experience was so practical and helpful, if and when the real situations arise.

For all of you prospective Community FM interns, once certified, you will be eligible to train as a course instructor. The ALSO course is taught worldwide and provides much needed skills and information, especially for providers in developing countries.

The clinic is closed on Tuesday afternoons.  Contrary to public expectation, nobody is golfing.  Except maybe Chris.  We have a "dedicated" didactic block for the residents to attend lectures on pertinent topics in family medicine.  For me, being on medicine service for the past month, "dedicated" means make it when you can.  For everyone else, Tuesday afternoons are a great time to catch up with all the residents.  
    I caught up this past week in August.  The meeting was at the Community Rehab and Sports Medicine center across from CHE.  We got to see for ourselves where our patients go and what they experience when we send them for PT/OT.  Coming from training as an Osteopathic Physician, my philosophy on health is that the body is an integrated whole with an inherent ability for self healing. We are taught appreciation for the body's interrelation of structure and function.  I've used musculoskeletal manipulation of various forms to optimize the physiology of my patients.  At the rehab center this approach to healthcare happens daily.
The clinicians at Community were dedicated and impressive.  The treatment plans are very well thought out, and outcomes of each encounter are measured to improve overall care and to show objective results. The training facility is first rate. The talented people there complement our work in the clinics and give patients the consistency many chronic problems require.  Thanks for lunch and the impressive tour, your work is vital.

    Next, we returned to CHE for an interactive lecture on sleep apnea.  We were introduced to the various CPAP masks and machines.  It was a real eye opener (and nostril opener). 
    The day ended with an earfull of information from  Dr. Matthew O'Malley a neurotologist who recently joined the Midwest Ear Institute and specializes in ear, hearing, and balance disorders. He honored us with his expertise in this area and we are all grateful.  Welcome to Indianapolis.
     It felt good to meet up with everyone again, (there are actually eight of us interns!) I enjoy these Tuesday afternoons - they are a breath of fresh air.
    
      

We are pleased to introduce Dr. Michael Leins as our blogger for the Family Medicine Residency program.  Please stay tuned for more details!

John W. Fleming, MD
Assistant Director

When I was nearing the end of my third year as a medical student I spent a month in Kingman, Arizona for a rural family medicine rotation.This was “full spectrum” family medicine with more OB than most formal rotations. I liked the responsibility, had a call pager, would come in to the hospital at all hours of the night for deliveries. Usually beating my preceptors there. Disconcerting, sitting gowned and gloved in front of a crowning baby inching its way to the first cry. Once I made the mistake to ask the nurse if the attending had showed up yet. I was so nervous it would just be us in the delivery room. She went to check–then it was just me, mom, and and an imminent birthday party.

One of the scariest moments, however, was over before I could fully appreciate the seriousness of the situation. I was delivering yet another baby in the wee hours of the morning when awkwardly, the baby stopped in mid-delivery. The preceptor, usually sleepily coaching, sparked to life. In a flash he was angling and maneuvering the baby and the mother’s legs. The baby came out normally after that, it seemed to me. “That was shoulder dystocia!” he exclaimed in unfamiliar exasperation. The baby was positioned with the shoulder pinned behind the mother’s pubic bone and would not budge. Life threatening to mother and baby, knowing what to do in this situation is essential.

This and other nightmare scenarios were drilled into us for two days at The ALSO course for high risk obstetrics. As FM interns we have two months of OB and our continuity patients to care for as well so the training was much appreciated.

The lectures were presented at a fast pace at the beautiful Valle Vista country club, with its spacious lecture halls and home to an impressive golf course. While this was unexpected, the atmosphere was reminiscent of the floor (where the hospital transforms into a cozy, floral environment). Another pleasant surprise was that most of the FM residencies in Indianapolis and one from Terra Haute (with my AZCOM classmate as a new intern) all attended the training together. Everyone got along very well, especially over the lunch break. I haven't laughed so hard in a very long time - thanks to Chris, Anna, Katie, Laura, Rachel, Kelly, Adrian, and Amy. Not only did we get the firsthand experience of the Community attendings, but the attendings from the other programs as well. It was an impressive bunch.

Along with the lectures, we had numerous workshops including forceps training, vacuum extraction, post partum bleeding, shoulder dystocia (remember suprapubic pressure), and laceration repair training on real cow tongues!All of this increased my comfort level with OB, and I will definitely still keep the “phone book” handy. The culmination of the course is the “Mega delivery” where we apply everything we learned during one unfortunate scenario on a plastic mom and baby model. Everything that can go wrong does. Before the exam, the halls were filled with studious residents reviewing their notes.

I’m grateful for running through it all on models – it was stressful and tense situation where seconds count. The entire experience was so practical and helpful, if and when the real situations arise.

For all of you prospective Community FM interns, once certified, you will be eligible to train as a course instructor. The ALSO course is taught worldwide and provides much needed skills and information, especially for providers in developing countries.

  Graduation. The very last day of our two week orientation to the program Hundreds of people including the interns, were all formally invited to the Garrison banquet hall for the class of 2008 commencement.  This was an intimate and much anticipated event. People who have been with the program for 30 years or more were in attendance.  The printed programs at each seat featured the eight graduates. It was on reading this that it sunk in - we're all going to have to give speeches! Not tonight, not us anyway, but in three years we'll be the eight up there . 


 
    Excitement and terror came over me, again.  You would think that after two weeks I would have been used to it, but this was at a level I've seldom experienced.  Only once before, actually.  When getting my wife's engagement ring melted down to redesign it.  With the wedding date set in stone and empty-handed, the anticipation of those anxious days approached unbearable.  December's ceremony came and she had her ring, thank God, seeing it for the first time.  
     A three year horizon set, and I find myself with a familiar anticipation - having only raw materials and fear.  Community trains great Family doctors, as evident by this night.  As we interns take our first steps into the fire we see a glimpse of our refinement.  Surrounded by doctors who have gone through the program,  and those graduating on stage, is an immense encouragement.  

    
    For those of you looking into the program, which should be all of you, I will let you in on a little secret that may help postpone the inevitable.  THE FACULTY AND NURSING STAFF ARE TAKING NOTES. EVERYTHING YOU DO CAN AND WILL BE USED AGAINST YOU AT THE ROAST  BEFORE GRADUATION.  Apparently they've already got a "pen incident" on me from my residency interview.