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

References:
Barna K, Brasch G.
Orv Hetil. 1981 May 17;122(20):1183-4. 

Med J Aust. 1974 Apr 13;1(15):591.Letter: Epidemic vertigo. Williams S.

Zh Ushn Nos Gorl Bolezn. 1971;31(2):115-6.
[Atypical case of vestibular neuronitis, observed during the influenza epidemic in 1969 in Leningrad]. [Article in Russian]

S Afr Med J. 1964 Aug 29;38:709-10.
Epidemic Vertigo. James T.

Brain. 1962 Sep;85:613-20.
"Epidemic vertigo"-"vestibular neuronitis". A clinical study.
Harrison, MS.

Brain. 1959 Dec;82:566-80.
Epidemic vertigo, Clinical picture, epidemiology and relation to encephalitis. Penderson E.

30 comments:

  1. Thanks Paul. For me it's cold/cough #3 since I left for the Antarctic in Nov. Perhaps it's all those hours on airplanes, but seems just the simple annoying cold.

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  2. beautiful and helpful summary of what I've been seeing. . . thank you.

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  3. Thanks, Paul. I've been confused with all the different "flu" presentations around here. This helps.

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  4. Thanks for a very useful differentiation. (However, it is Baptisia, not Baptesia.)

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  5. Thank you very much for your thoughtfulness. I have seen a low grade lethargic re-occurance with dizziness too and have given Nat-mur with some success.

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  6. Good summary. I personally did well with Rhus Tox, and have seen benefit from Arnica (body ache version) and Causticum (productive cough version).

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  7. I personally have benefited from Gelsemium -- but only 200c really did it. My symptom was the super duper tiredness, with an usual modality of improvement when it became dark outside, and much worse after eating breakfast and lunch. 30c had only a mild if no effect. 200c had a dramatic effect.

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  8. Pulsatilla helped one woman with bronchitis, lethargy, > fresh air, dry at nite, productive, yellow in AM, changeable body aches, no appetite,no chills, all after feeling forsaken.

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  9. This comment has been removed by a blog administrator.

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    1. This was done per the request of the person posting it.

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  10. Thanks for your useful analysis and description.
    I can say that in Spain -at least in Barcelona's area- Arnica is acting very well in the headache+weakness group if given the first 1-3 days, and one dose each 2-3 hours until strong amelioration, about 2/3 of cases aprox.
    For the longlasting cough, some cases responds well to Rumex, although the charasteristic symptoms of Rumex are not found seemengly -phone prescription-, only the cough that prevents to talk.

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  11. Thanks Paul for this summary. It certainly reflects what I have been seeing in my clinic.

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  12. Thank you for sending us your updates! Would be great if we had a location that we could send updates to, to be collected so we can help each other during times such as this....NCH had started one several years ago but did not seem to take off.
    Had not come up with Baptisia at all - thank you! I think two cases would have been helped by it - extreme prostration, total loss of hunger, coryza, chills (did not have the confusion of mind) - one of the two felt that her feet were not her own and actually felt,large, padded with claws almost like a bears!
    Rumex helped in a couple of cases, especially with there was an incessant cough coming on at night once in bed.
    Have seen much stomach 'flu' where patients have come down with it again after a week or two.
    From NJ

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  13. Is posology an issue in the relapses? I'm thinking that given the intensity of the epidemic, treatment may need to be similarly intensive: we may need to be especially aggressive about repetition (higher potencies than we might otherwise think?) and continuing the repetition after apparent recovery.

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  14. Great information, thank you! I have also had some Group I/Group 4 cases that have responded very well to Eup-per, especially when Bryonia seemed well-indicated but didn't act. Also, for the lingering dry, tickling cough I have used Spongia with success, along with Drosera, Rumex, Bryonia, etc.

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  15. Many thanks for providing this resource for influenza. I have learned a lot in reading the different groups, the newest symptom pictures and remedies which may not exhibit their typical keynotes will help overcome the illness. Sincerely, Debby

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  16. I have seen many dramatic recoveries with Gelsemium 30C, including with myself and family members back in Oct. I experienced lethargy to the point of not wanting to move or think..even asking for assistance was apparently impossible so struggled on in blurry apathy until it finally became clear after 2 other remedies only somewhat helped. I thanked the Homeopathy gods once again personally. It showed me more levels of gelsemium to see in others with this epidemic. The same lethargy took a client 8 hours to get out of the house to get her Gels, then once she did the change was amazing. Some required Eup. Perf. afterwards. Pulsatilla has also been popular.
    Note, Gels. is one for abuse of lead. The brain and central nervous system symptoms are very likely related, as lead is a major component of chemtrails, among other ingredients. Much of what we're seeing include an array of reactions to these poisonings. See symptoms listed here:http://www.stopsprayingcalifornia.com/Lead.php

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  17. Thank you for your confirming what I thought through this time of illness as well. I can not remember a time when one bottle worked for everyone I came in connection with but it did during this illness. The two main things were Virosode and the herb olive leaf and or echinacea.With some they used Vit C. too.I encouraged No refined sugars in the diet. Some children we also used Natural Creations childrens cough syrup. Thank goodness especially for the Virosode and Herbals!!

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  18. This definitely teases out what I have been seeing up in Alaska, mostly groups 1,3 and one or two of group 5. In group one also Nux-v, Gels, ACON when first seen and in the first day or so, though one woman reported taking ACON 30 tid for 1 day, bid for 2 and subsequently once a day til she was totally back on her feet. Group 3 Drosera, Cuprum, Bryonia, Bell, Group 5 Silica, Gels, and most interesting, Bar-c with very rapid results on the mental sphere. Influenzinum has seemed to curb the initial onset if caught early enough in 2-3 people. Quite a year! Olive leaf extract, high doses Vitamin D and C has also curbed the lengthy nature in a number of people.
    Thanks for the update Paul.

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  19. Thank you for this useful analysis. I have personally used Belladonna 200C in late 2012. Extra vitamin C also helped my family.

    Jyothi

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  20. I also used Silica successfully after Kali-s to clear up a lingering cough.

    Also, with respect to the cognitive syndrome, be aware that a new spirochetal tick-born disease, caused by Borrelia miyamotoi, has been discovered in humans in CT by a group of Yale researchers. It was discovered in ticks in Japan in the 1990s. Later, in 2011, humans in Russia were found to be infected with it. The Yale study is the first to find it in people in the United States.

    Although the new spirochete apparently causes similar symptoms to Lyme disease (caused by Borrelia burgdorferi) researchers say it would not show up in typical Lyme lab tests.

    Candace Benyei

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  21. Maybe also good to know ist that THE CAT brought this "influenza" into our house. I was the second one who got it, than THE RABBIT follwed by my husband. The rabbit died. The cat recovered with Mucosa compositium, Echinacea compositium.

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  22. This is so helpful! Funny you mention Conium with the vertigo. One case with a constant cough, from itching/tickling in the throat, larynx, chest. Just wanted to remain in bed. Seemed to be Nux or Puls but only temporarily ameliorated. Conium helped almost immediately - near constant cough to no coughing at all for 8 hours. Then a return of cough, redose of Conium, 30c - complete cure. No cough again - all well.

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  23. I've had vertigo for the last two weeks, woke me up in the middle of the night (very very severe), a couple of days I even vomited from the nausea. I went to the hospital after the 1st day, did some tests, EKG was fine, blood tests showed low RBC low Iron (9), they said it was due to my iron drop. I've always been iron deficient. My head felt full and I had whushing in the ears...they dismissed my comment. Next day felt more head congestion, ears felt clogged, sore throat, went to walk in and was prescribed antibiotics. At that time I was taking antibiotics, zyrtec D, iron supplements and stool softner, still with vertigo I called doc and asked for ear drops which he prescribed (neither dr. nor hospital saw anything in my ears). Used ear drops for couple of days, still vertigo, no more sore throat, but feeling of pressure in my ears....went to see ENT who did Epley maneuver for right ear and said I had Benign Positional vertigo, told him that now my ears were ringing and he said that was unusual. My vertigo was brought on with change in head position, I was sleeping only facing up. Anyway, that night I was finally vertigo free and the next morning as I turn in bed all starts spinning again. I tried the Epley at home with no success. Decided to wait it out, went back to ENT after 4 days and he tried Epley on left ear since I told him now it was worse when I turned to my left....this was torture, I had done it once at home (left ear) and he did it 2 times in his office (left ear), vertigo did not go away. I've been waiting it out and I feel very off balance, can't look around too fast, can't really look up/down too much, still sleeping upright and facing forward. Yesterday I was watching t.v. and go a very very short vertigo attack and I was not even moving my head....have had tinnitis since. My medical background, have asymptomatic regurgitating valves in my heart, when I was diagnosed with infertility, tests revealed that I had a benign pituatary tumor, do suffer from ulcers from time to time, had symptoms of ulcer few weeks prior to this episode and took nexium for a while, have heavy menstrual cycles which occured 1 week prior to episode. I am hearing reports of vertigo virus, my husband's friend's wife was just also rushed to hospital with vertigo. What should I do? Wait it out? Get an MRI? Get antiviral drugs? Unfortunately I do not have a general doctor that I know and trust. Please advise.

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  24. Both the doctor and ENT said that my vertigo was unrelated to iron deficiency.

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  25. what has happened to Rosa sounds like what is going on with my son in terms of vertigo and perhaps it being a virus. Any suggestions on remedies?

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  26. I live in Australia and I have the vertigo at the moment. My head feels clouded, i have a loss of balance and nausea.The only time I feel remotely better is lying down. Someone else I know has it too.

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  27. I turned over in bed at around 3:00 AM Thursday and was hit by horrible dizziness. I started dry heaving as nothing was in my stomach. We ended up in the ER and everything checked out fine, even CAT scan. I was weak and tired the next day but hungry and could eat. This happened on vacation. We traveled back home and now 2 1/2 days later, I am still off. My vision seems to have changed, I am tired and don't want to focus for long periods of time. I don't know if it is dizziness or just light-headedness. I am physically fit, eat very naturally (real food), not overweight and take no medications or supplements. I am 57 and hope this is just a virus!

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  28. Hi, I live in Australia also. My wife and I had a flu/cold about 2 months ago, we both still have vertigo, mine is crazy and almost constant, her's is intermittent. When I'm lying down or in bed I can feel it but not half as bad as when sitting up or walking around. If I cough, or rub my eyes the vertigo is intense, I'm at the point of praying for it to go away. if this is a Virus? I'm hoping it means it will stop soon.

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    1. Vertigo after a cold can be labrynthitis (viral infection in inner ear). Allopathic treatment is Stemetil tablets 3 times a day.

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