November 01, 2009

It started with the usual blasé feeling and the body aches. This was followed within the hour by diminished energy and slowing of my ability to think and reason—and an overwhelming desire to nap. I knew I had been exposed to a patient with pandemic A(H1N1) infection, and it was clear to me that I had contracted “swine” flu.

I reported to employee health at my hospital, where I went through the procedure of getting a nasopharyngeal swabbing for an antibody test. I was quarantined until results were official.

Of course, given the 40% accuracy rate of the direct fluorescent antibody test for H1N1, it was bound to be negative. Indeed, it was. What to do? Do I take oseltamivir (Tamiflu) or zanamivir (Relenza), or do I wait it out? And what about my family, one of whom is immune compromised?

At the time, there was no official policy for treating suspected H1N1. So off I went to the pharmacy to get Tamiflu. Amazingly, I felt pretty well after just a few hours on the medication plus some acetaminophen. I felt functional and, since there was no one else to perform my duties, I donned a mask and went back to work. I had lost most of a precious day of seeing patients.

While the Centers for Disease Control and Prevention recommends a period of quarantine for health care providers who suffer from the illness, this sort of policy will not likely be implemented with any regularity. Let's face it, we work when we are sick, since there is often nobody to fill in and it is not possible to defer patient illness for another date and time. There are, after all, not enough primary care providers to serve the public and even fewer geriatricians to serve the elderly.

The following 2 days were not too bad, but by the fourth day, I was congested, could barely speak, and began coughing up something that looked like it might not have come from a human.

This was followed by several weeks of antibiotics, first azithromycin and then cefprozil plus azithromycin. Steroids and inhalers were added, and I was provided nebulizer treatments. Fortunately, or perhaps unfortunately, I was scheduled for a 2-week vacation, most of which I spent in bed. I thought perhaps I should consider prophylaxis against deep vein thrombosis but opted for ambulation and chicken soup, given the risk of Reye's syndrome with aspirin.

Finally, I decided that none of the medication was doing any good and that what I needed was good old fashioned exercise and fluids. So, I began to swim, as I have most of my life. I made sure to inhale plenty of the water as a sort of lavage. The first lap was torture, and I was amazed how much stamina can be lost in such a short time. But, over the next week, my breathing normalized.

After about 3½ weeks in the pool, I was off my myriad inhalers, antibiotics, and steroids, none the worse for wear and feeling back to being myself. I found myself wondering how our elderly patients would fare with such an illness, and I concluded that perhaps we are underutilizing two essentials of care for this patient population: water and exercise. Food for thought for all of us.

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