Re: For Dr. Furman: Needed, advice on how to react to respiratory infections

[Guest guest]

Laurie,

I think your question points out a very important quagmire that patients need to

avoid getting trapped in. There are several ways to approach this question.

First, CLL patients with the flu are still more likely going to have the classic

symptoms of the flu.

Second, the symptoms that will result from the flu will likely be more severe

than that of a common cold. If the symptoms are not that severe, then even if

it is the flu, you might be having a mild infection and not require anything to

be done about it. It was not until they started aggressively testing for H1N1

( " swine " ) flu that they realized there were millions of cases already and that

most patients were not sick enough to see a doctor.

Third, and most importantly, common things occur commonly. The likelihood of

having a common cold is extremely likely, while much less so for the flu.

The biggest problem with the statement made on CLL topics is the widespread

panic it might cause unnecessarily.

Rick Furman, MD

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> A question for Dr. Furman and others:  There was a recent article in CLL

Topics Udates (12-20-09)  regarding flu and immune surpressed people (such as

those with CLL).  One point made by Ms. Venkat was that people with CLL do

not tend to have the usual symptoms of flu such as fever and aches.  In many

cases, according to Ms. Venkat, the only indication will be a sore throat,

stuffed nose or sniffles. 

>  

> These symptoms it seems to me are indistinguishable from a common cold. 

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> Moreover in a web-link from the CLL Topics article by Ms. Venat there is 

a discussion put out by the  CDC, (Recommendations: Special Considerations for

Clinicians Regarding 2009 H1N1 Influenza in Severely Immunosuppressed

Patients 12/16/09)  It says;

>      "  Therefore, clinicians should suspect influenza in any severely

immunosuppressed patient with acute respiratory symptoms, with or without fever,

and initiate empiric antiviral treatment as soon as possible and send

respiratory specimens for real-time reverse-transcriptase polymerase chain

reaction... " . 

>  

> I would like some guidance on how to treat such situations.  Should we

immediately go to the hospital emergency room if symptoms such as a sore throat

or stuffed nose or a sniffle appear, and get treated with flu drugs such as

Tamiflu, even before a diagnosis can be confirmed? Or alternatively should we

have on hand  a prescription for Tamiflu and take it at the first sign of a

respiratory infection?  The former, at least, seems to defy common sense.  My

question is what would be a prudent, yet reasonable way to proceed?

>  

> Thank you

> Laurie Landy

> Washington DC

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