Friday, December 15, 2017

Influenza Like Illness, Winter 2017

Influenza Like Illness, Winter 2017
Part 1. December 8, 2017
Paul Herscu ND, MPH
Herscu Laboratory

Here we are at the start of December. I have been treating what I believe are two separate viral infection presentations, epidemic at this time, in patients from Florida to Montreal, from Seattle to San Diego and many places in between. The first, which I am not discussing here is a simple, though severe gastroenteritis, characterized by nausea, vomiting, and severe diarrhea, ending with watery discharge from the bowels.

I want to focus on an unusual presentation of upper respiratory tract infections. During these URI infections, I see:

A.     Adult patients develop severe sore throats and laryngitis, with pain in the throat worse from coughing.
B.     Adult patients with sinus infections leading to ear infections and a sensation of ear stuffiness.
C.     Babies and young children with common symptoms of high fever, flushed face, listlessness, and irritability.
D.     The most unusual aspect is seen in the over 60 population. Oddly and surprisingly, numerous patients develop a URI which take an odd turn: they develop symptoms of asthma. The asthma is characterized by incessant cough, ending with in a wheeze, audible by stethoscope or even without, when severe. Others say they inhale as usual, but find it difficult to exhale properly.

These asthmatic symptoms are atypical to these patients. They have told me that these are the symptoms they recall from an asthmatic child or grandchild, but they have no history of asthma themselves.

This unusual presentation has confounded many physicians. Typically, when you hear this set of symptoms in an older adult patient, you must rule out pneumonia, but X-ray does not confirm this. And while it is influenza season, these folks may not have true influenza. Lastly, due to a sort of confusion, or lack of understanding, many of these patients have taken antibiotics, which do not help the viral infection. Physicians end up saying something like, “I think this is viral, and will pass, so let’s just control the symptoms with a fever reducer,” or “I think this is viral, but you have symptoms of pneumonia, so let’s give you an antibiotic, even though it does not seem to help all patients.”

This is an odd presentation and an odd time of year, hence this post. I want to share two ideas. First, what I think is happening. I think what we are seeing is a virus, which in part explains why antibiotics do not work. And specifically, and this is my best educated guess, I think we are dealing with Human metapneumovirus (hMPV). It is similar to RSV. Most people, including clinicians, are not familiar with this bug, even though it was discovered in 2001 and causes a large percent of winter ailments. Clinical work can take years to catch up with science. And second, there is no specific treatment or vaccine to date. As soon as a vaccine is developed, there is going to be a big push and discussion of how bad this virus is, how dangerous this bug is. Until then, it is mostly not discussed. This is not to say that other viral infections, including influenza, are not around, but this presentation is different.

While the symptoms caused by hMPV are common to influenza like illness — fever, runny nose, body aches — it does do one more thing. It produces, in some children, an asthmatic crisis. In other words, this virus triggers reactive airways and asthma, in children. Even in those that do not have asthma. (And to be clear, I am not referring to children that are settled with asthma triggered by URIs, which is a common finding. I believe this is a single non-chronic event.) What I describe, or hypothesize here, for the first time, is that the same thing occurs in older folks. Which is why I think this is the bug that is causing these odd symptoms. And the fact that this is a novel population leads to the confusion.

I want to highlight one very important point. This year is going to be challenging as it is, with the influenza vaccine efficacy rate estimated at around 10%. But adding to the complexity of lack of efficacy is this other viral presentation. If what I have seen continues, what we will find by the end of the flu season is many people thinking they had the flu, and pneumonia on top of that, took antibiotics, and suffered needlessly. What we really need is to developed a simple nasal swab to tell us if vMPV is causing these symptoms, and treat appropriately. Proper diagnosis always precedes proper treatment.

In my practice, aside from antiviral protocols which consist of nutritional supplements, and botanicals, the most common acute homeopathic remedy needed, the current genus epidemicus is Lycopodium. I know homeopaths have prescribed all sorts of remedies here, but if their patient does not need their constitutional remedy, as many might, and you determine this to be a true acute situation, Lycopodium is most likely indicated. The Genus epidemicus has been shifting from Gelsemium originally, to Lycopodium now, and Causticum vying for second place. It seems as though Lycopodium hastens the resolution of this acute.

Keeping in mind our typical outlook of epidemics, as described elsewhere, like Herscu Letters #33-38, and making sure your patient is kept safe, consider Lycopodium for the genus epidemicus at this time. Specifically, in the adults, we have seen sore throats that are better from warm drinks, in chilly patients, yet their breathing is better in cool air. You may find sinus infections which are associated with stuffiness felt in the ears, most especially the right ear.

Stay tuned, I will add to these updates as needed.
Happy holidays and best of luck with your patients.

Yours sincerely,
Paul Herscu ND, MPH