An Update on the 'flu, 31.December 2013 (updated 28.January)

google flu trendsSubsequent to my presentation on influenza on December 12th, we've seen a precipitous development of seasonal influenza across North America - particularly in the Gulf Coast and Northwestern regions.

The CDC has been reporting strong dominance of a 2009 H1N1 strain, A/California/7/2009-like; which is included as a component in this year's vaccine.  However I've seen significant illness in 2 individuals who experienced the 2009 'flu - including myself - (and therefore could be expected to have had partial immunity), suggesting the possibility of significant antigenic drift, or perhaps shift, from the A/California/7/2009 strain. 

I'd like to present a group anamnesis of my family's experience with the 'flu over the Christmas holidays, both to offer an early estimation of the Genus Epidemicus of this year's 'flu epidemic, and to demonstrate the process in practice.  If my process seems a bit bumbling, so be it - it was.  I am no Samuel Hahnemann, however much I might strive to be.

Case 1 - my 5 year-old Granddaughter:
(presumed retrospectively to be 'flu, though not apparent at the time)
Onset of illness: overnight December 20/21.  "High" fever (no thermometer, & her mom tends to overrepresent these things).  MIld/modest fever when seen 12/21 in the morning.  Fussy, capricious, asking for/refusing attention.  Nondescript upper respiratory symptoms - stuffy, scant clear to yellowish nasal discharge, dry to rattly somewhat spasmodic cough.  Throat normal, no ear discomfort.  Some tender lymphadenopathy upper anterior cervical chains.  Lungs clear.  Stools normal.  Frequently benefits from Chamomilla for upper respiratory complaints.  Given Chamomilla 30C.  Gradual full recovery by morning 12/24.  (It was unclear whether the Chamomilla actually contributed to her recovery).

Case 2, Case 3 -
My eldest son & his partner, case 1's parents:
Onset of illness: December 24 evening.

Case 4, Case 5 -
Mary & Me; exposed to case 1 on Dec. 21 & 22, & to cases 2 & 3 on the morning of the 25th.
Onset of illness: December 26 morning.
(The closest observations were made on these two cases).

I did not recognize this to be "flu" until day 2 of cases 2/3, when its severity & character became clear.  Flu surveillance in the community was still reporting low levels.

I chose to not treat myself, but to observe the chronology of my symptoms carefully to see if I could discern the totality clearly in myself.  Quite an adventure, and valuable in this case, as it provided the clearest individual picture of the disease, but not to be lightly recommended :^(.

Remedies given to others until the Genus became clear,
included Eup-per (to case 2, when body pains and headache were the most concerning symptoms; and needing the greatest apology, in retrospect), Nux-v (to cases 2, 3, 4), Sanguinaria (to cases 2, 3, 4) based on careful assessments of the individual & collective totalities available at the time.

Development of full expression over 3 days in cases 2, 3, 4, 5 (this pace of course, was not recognized until full expression was seen, on day 3 of the illness in the first clear cases, cases 2 /3 !)

Day 1, cases 2, 3, 4, 5:
Mild nasal congestion with minimal to no discharge (clear, thin, scant at most), variable partial obstruction.
Tickling/itching/irritation of "throat" (upper trachea, behind sternal notch)
Dry, increasingly spasmodic cough driven by this "itching"
Feeling as if needing to bring up expectoration, but none raised
Aggravation of respiratory tickling & cough from any motion or exertion (aggravation from any motion or exertion later emerges as a general modality)
Mildly chilly (turning up the thermostat, warm baths, bundling for comfort); relieved by external heat

Day 2, cases 2, 3, 4, 5:
Increasing tickling/itching/irritation upper trachea, behind sternal notch; in 1 case (me) extending downward toward tracheal bifurcation & proximal bronchi, with increasing frequency of spasmodic, dry cough
Alternating Chills / Heat - every half hour to hour; chills worse or brought on with exertion or motion; relieved by hot bathing or heavy covers
Headache (intensifying and gaining clearer character later, on day 3)

Day 3:
all day 2 symptoms intensifying
Headache one of the most debilitating symptoms; variably:
- occipital ridge, as if from a blow; stunning pain (case 2)
- forehead above eyes, extending into eyes; sore, severe ache (in all cases)
- eyeballs & behind eyeballs, extending into forehead (cases 4, 5)
- both forehead & occiput (unable to describe whether forehead to occiput, or occiput to forehead)
- in case 5 (me), a feeling of needing to crack my right atlo-occipital articulation, with sore pain extending from there to my right eyeball
- flitting neuralgic pains about head, moving about erratically (case 5, prominently)
Headache much worse any exertion or motion
3 cases (2,3,4) with photophobia;
Headache better temporarily with very hot applications (hot moist towel over eyes & forehead; lying in extremely hot bath with head submerged or hot wet towel over face
Body pains:
- one case (case 2), as if in bones of joints (starting on day 2, intensifying on day 3)
- one case (me), severe lumbosacral junction pains, as if broken, severe sharp pains with every cough (much sharper & more acute than my usual sacroiliac discomfort related to chronic Ankylosing Spondylitis)
- one case (case 4), soreness in ribs, with sharp pains in the rib cage on coughing
Day 3 especially, dominated by extreme debility, difficult to engage in any activity, much worse with any attempt at exertion or motion; sleeping much of the day; one case (case 4) mentioned a few times “everything that needed to be done” that she felt unable to get to, but this is her norm, and it was perhaps more remarkable that this concern was much less than might be expected

day 4 
(just me now, I'd already treated the others now with the discerned Genus remedy, & these cases were on the mend)
several drenching perspirations following heat phase of fever (chill - heat - perspiration), soaking bedclothes & bed, followed by remarkable amelioration of headache & “sick” feeling; followed by chill & return of all symptoms to their prior levels
(at this point these "careful observations on myself" were feeling a bit old, and in my misery, I "bailed" from my observations and took the Genus remedy myself).

"non-case" 6, my younger son, was exposed later than the others, on Christmas day -
on 12/26 he began prophylaxis with Oscillococcinum, changed to Gelsemium when the genus became clear - he developed a very mild tickly cough & nasal congestion, better subsequently despite 10-hour shifts on his chef’s job & 2 punk rock shows eroding his sleep.

gelsemium sempirvirensGenus Remedy discerned as Gelsemium sempirvirens 
(I'll let you do the analysis based on the group anamnesis above).
Just remember, the role of a Group Anamnesis in epidemic disease is NOT to render the sketch of the disease image as "larger and more verbose," but rather to permit "the general signs ... [to] obtain their own narrower determinations" and to allow "the more marked, particular, and (at least in this connection) rarer symptoms, belonging to only a few diseases, [to] emerge and form what is characteristic for this epidemic."  Re-read aphs. 100-102 in the Organon, where Hahnemann spells out this process.

Given as 30C in water (2 pellets in 4oz), 1/2 tsp every 1/2 - 1 hour.
Response in all cases was rapid, with clear benefit appreciated within an hour, and gradual resolution of symptoms over the following 24-48 hours.  The most lingering symptoms have been a "rawness" or irritation in the trachea behind the sternal notch, and a "swimming" feeling in the head, worse motion and exertion.

Prophylaxis to "non-case" 6, 30C, 1 pellet twice daily initially while we watch community activity.

addendum 28.January 2014:

Google Flu Trends
indicates some plateuing or settling of 'flu activity over most of North America, with sparing so far of the northeastern states.  Europe has seen little activity, other than Spain and Bulgaria.  Japan is currently seeing intense activity.

I am seeing a few cases which present initially with an obstructed nose with fluent discharge, benefiting from an initial dose or two of Nux vomica, followed then by Gelsemium as symptoms change to more clearly indicate Gels; as well as cases presenting initially consistent with the Genus, benefiting initially from Gelsemium, but requiring Nux at the close as symptoms change to indicate this 2nd complementary remedy.

Cases which progress rapidly to bronchitis or suspected pneumonia, 
or which progress to bronchitis following an otherwise "normal" course of 'flu symptoms, have been developing exacerbation of spasmodic cough driving by extensive substernal tickling/itching/irritation (no longer confined to the larynx / upper trachea) and other expressions characteristic of Sanguinaria, and benefitting from this remedy.

Last modified: Tuesday, 28 January 2014, 10:16 AM