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M. P. Ravindra Nathan
By M. P. Ravindra Nathan, MD, FACP, FACC Director, Hernando Heart Clinic, Brooksville, FL Editor-in-Chief, AAPI Journal

All my family members went to Kerala a few weeks ago to organize and celebrate the marriage of my daughter, with all the traditional religious rituals and glory in the presence of a lot of our relatives who otherwise would have been left out. Everybody was looking forward to a good time. And for me this was a sabbatical for seven weeks, of which, one week was spent in London, visiting my old Royal College of Physicians.

So, we all boarded different flights to the same destination – Cochin International Airport. Yes, my wife and I survived the extensive security checks in Orlando, Heathrow and Dubai and finally landed there in one piece. From then on, it was one illness after another. I miscalculated the power of viruses and all the other snafus.

The night before the wedding, one of my family members, whom I shall call Dr. C, who traveled from USA, suddenly developed pain and swelling of the left knee. This was followed by high fever, chills, fatigue and a little skin rash. Since the local newspapers were replete with stories of outbreaks of dengue fever, ‘rat fever,’ malaria, filariasis and many non-descript virus infections, we didn’t know which one hit him.

“Looks like septic arthritis though,” the local internist pronounced his diagnosis, after a quick examination. “You better get admitted to Amrita, right away,” he suggested. Amrita Institute of Medical Sciences is a well-known medical center in Cochin with top- notch physicians, so we knew help was available.

“But …” I was lost for words. “How is he going to attend the wedding ceremonies tomorrow?”

“Oh, what timing? I traveled 15,000 miles to attend this wedding and look …” Dr. C’s voice trailed off in disappointment. His mental anguish was equal to his physical symptoms.

In the hospital, the ER physician called the orthopedic surgeon first. The professor of Orthopedics arrived with an instrument tray and said somewhat assertively, “Need to tap the joint first.”

“Don’t you think you should do some basic work up like a blood count and a blood culture before putting a needle in the joint?” Dr. C asked politely, trying not to offend his sensibilities. “I am worried about any infection being introduced.”

“No, If I don’t tap it, you could lose the joint,” he seemed adamant.

“I would prefer if you would call the medical specialist first,” Dr. C put it a little strongly this time, covering his offending knee with the hospital blankets. The professor reluctantly acceded.

Dr. G. Rao, chief of Medicine, came promptly to evaluate the situation. The essential blood work was done right away and he seemed to have a better handle of the situation. Clearly, he had seen many similar cases. “Looks like a typical case of Chikungunya virus infection. South India is now going through this epidemic. Often start with joint pains and swelling. Easy to mistake it for septic arthritis. Will give you IV fluids and symptomatic medications. That is all what is needed. Most patients get better in 3-4 days but it has the potential for dangerous complications.”

As it turned out, the blood cultures were negative for bacteria and his symptoms subsided in three days and he was discharged. When asked how one can confirm the diagnosis, Dr. Rao said, “Dr. C, there are thousands of viruses here! Not easy to confirm the specific nature of any virus. We generally go by the clinical picture.”

Thank god, there was no septic arthritis but even after six weeks, Dr. C still feels fatigue and joint pains especially after mild exertion. It is a slow recovery process.

In the next issue, read more about Chikungunya, travel advisory and other infections.

Cardiologist Dr. M. P. Ravindra Nathan, director of Hernando Heart Clinic in Brooksville and editor-in-chief of the AAPI Journal, lives in Brooksville.

Payal Patel

Influenza A and B are types of viruses that cause the flu. The usual time frame is from November to April with the peak months usually being January and February.

The flu is an upper respiratory infection of the nose and throat and sometimes the trachea and bronchi. Most people usually have a bad cold that consists of nasal congestion, sore throat, cough, along with headache, fever of 102-103 degrees for 2-3 days, body aches and general tiredness.

It generally lasts for about 10-14 days. More severe symptoms are associated with babies usually less than 6 months and the elderly. The complications of the flu are usually a result of secondary bacterial infections that can lead to pneumonia, ear infections, sinusitis and bronchitis. The flu is usually spread via air through sneezing, and coughing, along with indirect contact with secretions on a person’s hand or objects such as toys, door handles, etc., and then touching your own mouth or nose.


Children more than 1 year of age, who come to the office before 48 hours from the start of flu symptoms, can receive a medicine called Tamiflu. This does not completely cure the flu, but it shortens the flu symptoms by 1-2 days and prevents the complications that can occur with the flu. Otherwise, the treatment is generally supportive with fever and body ache reducers such as Tylenol and Motrin, saline suctioning, over-the-counter cough and cold medicines, and plenty of liquids.


Prevention consists of vaccination, limited contact with a sick person, limit group settings such as a daycare, birthday parties, etc. Proper hygiene such as hand washing, and covering the mouth and nose when sneezing or coughing also decreases the risk of infection.

The flu vaccine

There are two types of vaccines available at this time. The flu shot is recommended for all children ages 6-23 months old, and children more than 6 months old with chronic heart or lung conditions or those on long-term aspirin therapy, pregnant women, household contacts and caregivers of children less than 6 months of age. The other form of vaccine is called Flumist, which is delivered via the nose and is recommended for healthy persons 5-49 yrs of age. Both the vaccines have to be taken every year. Side effects of the vaccine include mild flu-like symptoms and egg protein sensitivity.

Why vaccinate?

Vaccination is highly recommended for those with chronic condition such as asthma, sickle cell disease and other immunodeficient and chronic heart and lung conditions. If we also vaccinate healthy children, especially the school-age group, there is reduced transmission in the community. It also prevents disease in high-risk elderly, and reduces the cost of acquiring the actual disease and its complications. It also interrupts influenza outbreaks in the community.

The best time to get vaccinated is starting late October to early January while the vaccines are available. Some pediatricians may have a limited supply of the flu vaccine and may reserve them for those with chronic illnesses, but there are plenty of flu vaccine clinics held each year, and flu vaccines also are available at walk-in clinics.


Bronchiolitis is a viral infection of the nose and throat, and sometimes the lungs. Most common virus is the RSV but can occur due to other viruses. Unfortunately, In Florida RSV is present for the longest time frame each year from October to April with cases occurring throughout the year.

Infections are usually present in approximately 60 percent of infants less than 6 months and about 80 percent less than 1 year of age. For most people, the virus causes the common cold, but for children less than 1 year and those with prematurity, chronic lung disease such as asthma, chronic heart disease, and immunodeficiency and exposure to smoke, it can be associated with more severe symptoms.

True bronchiolitis consists of difficulty breathing with rapid rate of breathing, coughing, wheezing and shortness of breath. The bronchiolitis symptoms are worse for 2-3 days with gradual improvement over a week with cough and nasal secretions lasting about two weeks. During this time, the virus is shed and therefore can spread to others. This again can be prevented by hand washing, limited contact with a sick person and avoiding group settings. The treatment is usually supportive with saline suctioning of the nose, warm humidified air, and encouraging liquids. Some children with bronchioltits may get a trial of asthma medicines by your doctor at the sick evaluation in the office.

Dr Payal Patel , a board-certified pediatrician in Tampa, can be reached at

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