Friday, September 2, 2011

DENGUE SEASON: What's the Reason for the Season

Not a season of giving, Not a season of joy. It is a time when happiness means increasing platelets, decreasing pleural effusion, increasing blood pressure and bleeding cessation. It is a time when ecstasy is felt 72 hrs after the last febrile episode and good urine output.
There are ANSWERS parents should know and QUESTIONS parents should ask.

1.   My kid has 8 hours fever only, should i bring him to the doctor already?
                       If you’re certain that the fever just started 8 hrs ago and there is no associated vomiting, difficulty in breathing, cough, refusal to feed, headache, irritability, seizures, tummy ache, diarrhea, it’s ok not to bring him yet to the doctor. Febrile illness whatever they are...looks the same during the 1st 24 hours of sickness. The doctor won’t know yet what he’s sick off during this time. Bring him after 48 hrs of fever. Meanwhile, give him dolan or biogesic to be comfy.
                       But if he has those associated symptoms, please don’t waste time. See a doctor.

2.  Can’t you do cbc , platelet count and dengue test  to know if he has dengue NOW?
                      Dengue has 2-7 days fever. We want it tested after 48 hrs of fever. If we did the test too early , it would be negative ,definitely. But it’s not the real negative.We want to test him on days that he has a possibility of being positive. And so, if the test yields negative...he’s negative. We can rest easy for a while, until our baby is 72 hrs without fever.
                     Some doctors who want to avoid discussions with anxious parents would write them off to the laboratory. (Not all doctors are good, smart or considerate.)  And if it turns out to be negative but your baby is still feverish, repeat lab should be advised after 48 hrs.
                     So, to save your baby from pain, to save you from hearing him suffer and to save you a little cash...have your baby tested only when it’s the right time.(at least after 48 hrs of fever)

3. What are the tests needed to be done to know if my kid has dengue?
                     A. Complete blood count, and platelet count. This test will tell the doctor if your baby has decreasing platelet, increasing hematocrit, decreasing wbc count and disproportionate differential count ...which will lead the doctor to suspect dengue. Most are normal on the first test(especially if its too early), multiple sampling is done.
                     B. Dengue Test or NS 1 test .This test will tell the doctor if the baby has dengue now, or a long time ago .This is the better test. Either the baby has dengue ,or has no dengue. Its a bit more expensive than the cbc apc. However if it test positive, this will not tell you how low is the platelet count  and other information given by CBC APC.(But hey, if this is positive on present infection...have your baby admitted. Don’t wait for bleeding gums or decreasing blood pressure...or else, you gonna get it.) I advise observation and close follow up for kids who has positive result for previous infection.
                     C. Other test are relevant only if your admitted at the hospital.(Let the doctors impress you when you're in the hospital with the magnitude of tests needed)

4. The kid on TV had one day fever, and then died 4 days later .They say it’s because of dengue. Can this happen to my child?
                    Dengue has 2-7 days fever. Complications come abruptly during the Last days of fever and the 1st day NO fever. Mothers usually notice that her usually hyperactive highly febrile child suddenly became unusually quiet, sweatingly cold (clammy is the perfect term), and very well behaved!?...with a little tummy ache and refuses to eat. This moment coincides with the sudden decrease in blood pressure, decreasing platelet, increasing hematocrit and other crazy stuff going on inside your baby's body. The doctor need to see your baby now at the ER...not tomorrow.
                    Unfortunately, mothers don’t bring them NOW but the day after tomorrow when bleeding starts or when the child is super weak. At the ER, parents have the same grief stricken teary eyed guilty look .They love their child so much but has neglected to bring the child early.
                     Getting blood is another big problem. During dengue season, securing blood is a dilemma.

5. Do doctors know how long your child will have fever because of dengue?
                     No. Because its viral in origin, we wait and anticipate problems. Give a lot of fluid.

6.Do the doctors know who would have complications?
                    No. We try to anticipate problems. But if your child has other diseases like bronchopneumonia or typhoid makes complication of dengue worse.

REMEMBER bring your child to the doctor when
1. at least 48 hrs fever (its the total of days your baby is sick, even if the fever is on and off, high or low)
2. there is sudden weakness or refusal to feed in a healthy child
3.has associated difficulty in breathing, cough, refusal to feed, headache, irritability, seizures, tummy ache, diarrhea
4.has bleeding from the nose, gums or anus, bruises, vomits coffee-like substance or black stools

How not to get dengue: When cleaning your house and the neighbor's is not enough, transfer to US, Canada, Europe where dengue is not endemic. (But because we are used to living dangerously, we're staying...right???!!!)

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