Wednesday, January 23, 2013

Current Influenza Epidemic - January 2013

Dear folks,

Well…what a winter this has been so far. As you are aware, the number of people ill with some version of viral/bacterial infection is high, much higher than usual. After reading the different reports from around the country and abroad from colleagues, as well as from medical authorities, I thought I would share some details from my experiences over these past months, in the hopes of capturing that information. I hope you’ll find it useful.

Over the past few months, Amy and I have taken care of numerous patients who were acutely ill. The first thing that seemed striking is that, there have been several different viruses, and shifting sets of symptoms, in a way culminating with the current influenza epidemic. However, regarding this current epidemic, I have noted some observations. Many people who become ill are ill for a short period of time, days or a week, and then recover partially, only to ‘become’ ill once more, in a sort of ebb and flow manner for weeks or even months. This is extremely atypical for the flu virus, which has a typical duration of one week or so. Most of these people were not properly characterized with a lab test to confirm an influenza diagnosis. Many of the people who are ill at this time, while indeed suffering from some virus or bacterial infection, are not actually suffering from the flu.

Confirming this potential confusion is the observation that many people have had gastroenteritis, leading to either vomiting or diarrhea. However, influenza as such, does not typically have those symptoms. Or to put it another way, when people say, colloquially, that they have the stomach flu, that is technically incorrect, it is not influenza that they are contending with, rather an illness caused by a different virus or bacteria.

And lastly, the media has not helped. Once more there is confusion, in lumping together all these acute infections as influenza. Of course these sorts of confusions are not useful to the clinician either. When practitioners think they are treating influenza, or are telling people to vaccinate/or not vaccinate to protect against this virus, they may be misdiagnosing and therefore mistreating the patient. As written elsewhere, I believe that this is a great mistake and that we need better, easier diagnostic instruments, which would allow us to treat people more efficiently & effectively. As an example, a patient, sick for a month should lead the physician to understand that the patient is not dealing with influenza.

Onward to the specifics, and this time it is a very interesting story.

As some of you are aware, I began to write about an epidemic that was not especially articulated, at least not in the United States. The primary symptom of interest to me was vertigo that came and went. Well, until early December that still seemed to be the most interesting symptom that would remain with people, sometimes for days, sometimes for weeks, and sometimes for months. As I described in those updates, I believed it to be a lingering symptom of a viral infection that was not being perceived as such, since while some people were having a full viral syndrome, with respiratory symptoms, many others had only the vertigo. New patients continued to present them with this complaint and I continued to be intrigued by this vertigo.

I began to search past literature, looking at old epidemics, trying to see if there was anything like this before. I found a couple of references in the literature to an epidemic of vertigo that was likely to have been viral in origin. (The references are listed at the end of this update.) So there have been documented epidemics of viral infections that had vertigo as the main symptom, an epidemic viral labyrinthitis. The main difference between those epidemics and the current one is that those ill from the past had more acute and severe vertigo. In contrast, we have seen people that sometimes had other mild respiratory symptoms, fatigue, and who had a milder form of vertigo come and go, for weeks or months. At that time, the main effective remedies utilized were Cocculus indica, and for some, Conium.

By November last year, other viral infections seemed to become clearly both recognized and tracked, the main ones being pertussis as well as other long term respiratory infections. By that time, the percent of vertigo as a presenting symptom began to diminish. The main symptoms aside from an intense, dry, teasing cough, was weakness. Belladonna seemed to be the main remedy at that time. Interestingly, and this is why I am mentioning it, the weakness seemed to be part of the vertigo in the prior time period as well as the newer cough/viral period. This brings us to December and January, and influenza, proper.

Many people are ill at the moment. We are getting flooded with emails asking what is the genus epidemicus, what remedy should I give? For better or worse, it’s just not like that this year, which is what we were thinking based on our own practice and which was confirmed by replies we received when we asked what you were all seeing. Instead, as it sometimes happens with these kinds of ailments, symptoms seem to congregate around several main presentations, delineated below. If you can take an appropriate case and think in these categories and know even the rudiments of the remedies listed, you should be able to help those in need.

Group 1. Some have the more classic influenza presentation: weakness, shakiness, headache, chills, as well as minor respiratory symptoms. For this group of individuals the four main remedies that have helped have been Nux vomica, Silica, Mercurius and Gelsemium. Use your knowledge of these remedies to differentiate among them.

Group 2. Here the main symptoms are gastrointestinal, and have very little to do with the other sick patients. Symptoms commonly found during this time point to Phosphorus, Arsenicum album and Nux vomica, depending on the symptom complex, thirst, chills and the mental state etc.

Group 3. Patients in this group have as a central symptom a bronchial cough, and have responded best to Belladonna, Bryonia and Drosera.

Group 4. For others, the main symptoms have been heat, sweats, body aches, as well as minor respiratory symptoms and fatigue. For this group of individuals the three main remedies that have helped have been Sulphur, Mercurius and Bryonia.

Group 5. The most interesting subgroup of sick people to me is those who seem out of sorts in the cognitive area. In this group, the main symptoms are severe, intense weakness and lethargy, a disinclination or inability to stand for a long time, and an inability to clearly give a cogent symptom story. In general there is a marked and unusual lowered level of cognition. These patients have a hard time putting sentences together. They are beyond lethargic, want to lie down, or sleep. Very often while attempting to relate their symptoms they may forget the question, forget what they were saying or about to say, all of the sudden the patient remembers they never took their temperature, did not know the day of the week, could not remember if they had eaten in the past few hours. They may well have chills, body aches, and minor respiratory symptoms. For this group of individuals, the two main remedies that have been helpful are Silica and BaptisiaAnd it is this group that I want to expand upon.

First, I am not sure what this group of patients has, but I do not believe it to be influenza. In no instance did any of them have a short course, and by the time I saw each patient, they had each been ill well over a week, not common for influenza. Second, what was most interesting is that their brain seemed to be impacted more than their body. The nervous system, especially the brain, seems impacted. Third, most of these individuals had taken Gelsemium prior to my prescribing Silica or Baptisia. And the Gelsemium had not been helpful. I mention this because many of us are familiar with Gelsemium, and its use in viral infections. The symptom of weakness is a key feature of this remedy. However, in this instance, unlike the group 1mentioned above, the nervous system was impacted even more severely. Another point of differentiation is that other keynotes of Gelsemium were absent.

The most common important presentation for Silica was, aside from more common symptoms, extreme chills with incredible fatigue and the desire to lie down. Note that constipation, common for the remedy, has not been present; sweats may or may not be present.

The most common important presentation for Baptisia is, incredible fatigue and lethargy, body aches, and a greatly lowered cognitive ability, notable forgetfulness, inability to communicate in a coherent consistent manner. In other words, I would have to repeat questions, and the patient may not recall simple things. There is a big keynote of this remedy that the patient smells horribly, but this has not been so. Also, there is a common finding of feeling like the body aches and confusion lead to a sensation that extremities were no longer connected to the body. This was definitely not seen. However, there was one symptom here that I believe represents the same idea. The patients forget about food. The concept of an appetite completely vanishes. And by this I do not mean that they simply were not hungry. I mean that they could not really relate to the concept of hunger and food, as if it were a foreign thing. For me, this is fitting within the same Segment of Baptisia confusion.

To encapsulate the main points: First, there are at this time, several different viral infections going around. Each infection actually has a slightly different presentation. I have received many, many emails from clinicians from many corners who confirm the presentations above.

However, the most important one has not actually been described, that of group 5. Specifically, I have received numerous emails where the clinician described their case, and as they believed it a common presentation of chills, weakness and fatigue, gave Gelsemium,  which did not help. I have had the opportunity of treating some of these same individuals, and I would say that most of those ‘Gelsemium looking’ patients actually needed Silica and Baptesia; the symptoms of the 2 remedies do overlap. Remember Silica though for when the illness comes and goes for many weeks, never really resolving.
Good luck during this time. I know it is confusing, and I also know that soon one or the other viruses will likely pass and then the picture will become clearer, with one set of symptoms predominating.

Keep in touch & continue to let us know what you are seeing.
Yours truly,
Paul Herscu ND MPH

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