Avoiding, Preventing, Treating H1N1- Evidence based information

[cillakat]

share as needed/interested. All information is mine and from evidence based sources. I didn't have time to cite......so do with it what you will.

 

http://docs.google.com/Doc?docid=0AV3S7fNjwg33ZHp0bWN3cV83NnhxZGd3a2N3&hl=en

 

Virtually all flulike illnesses currently presenting are H1N1. It's possible that 50% of cases are presenting without a fever and very likely many more. This makes meaningless, the recommendations to "stay home from school or work until fever free for 24 hours" as many with the flu will never have had a fever. Children are unknowingly being sent to school with H1N1; adults with H1N1 will continue to go to work not realizing that they are spreading the flu.

 

Contagion is a factor from 24h prior to onset of symptoms and for 7-10 days after *onset of symptoms*.

 

It's wonderful that most people are reporting being sick for 1.5-2 days. Yay! For those at risk for respiratory complications though (including our pregnant friends and family members) it doesn't matter that 'most' are sick for 1-2 days. For them, this is not a typical flu so please stay home if you have any symptoms. Please keep your child home if they have any symptoms. If one is sick, keep them all home.

 

What can you do to prevent or treat the flu?

 

Consider:

•Anti-Virals if you think you have the flu [CDC recommendation not mine] Keep in mind that there is a 50-90% false negtive rate on the rapid flu tests. Yes, you read that right. Just b/c you have a negative rapid flu test absolutely positively does not mean you are home free.

 

Effective treatment:

 

•Anti-Viral Medication started within 24h (less helpful but still helpful if started later....though drug resistant cases are emerging)

 

•High Dose Vitamin D3 therapy aka Stoss Therapy. (reduces cytokines) Stoss Therapy is 1,000 IU D per one lb body weight per day

FOR THREE DAYS,

then back to normal dosing: 1,000 IU per 25 lbs body weight. Stoss therapy is not appropriate for those with kidney disease. Take sufficient calcium and magnesium while taking vitamin D.

Likely Helpful adjuncts effective treatment - will reduce and/or moderate cytokines or act as ACE inhibitors:

 

•Aspirin,

Adults only;

never children or adolescents

(reduces cytokines).

 

•Green tea (ACE inhibitor, reduces cytokines). Consider drinking

 

daily and/or gargling with it.

 

•High dose vitamin C therapy to bowel tolerance. Use cheap ascorbic acid unless you personally need buffered - avoid time released for this usage.

 

 

Effective Prevention:

 

•Optimal blood levels of D3 (reduces cytokines)

 

 

•50-80 ng/mL is optimal; some say 50-70 ng/mL, some say 55-80 ng/mL - it depends on who's writing and when they wrote it. Anything less than 50 ng/mL=substrate deficiency which is a Very Bad Thing. Our 50-80 ng/mL translates to 150-200 nmoL in any other place in the world

Moderate levels are correlated, by some data, with increased cytokine activity (20-40 ng/mL). We don't want moderate levels or even 'normal' levels. We want optimal levels in the middle of the 'reference range'.

 

 

 

•Remember that because of problems with Quest's test, any D result from them should be divided by 1.3 to get an accurate number.

 

 

 

•Optimal vitamin D levels are your very best defense against influenza, some researchers posit that it may be as or more effective than a vaccine.

 

 

•Green tea (ACE inhibitor, reduces cytokines).

 

Drink it or gargle.

 

•Probiotics. Take daily.

May be helpful adjuncts to effective treatment and/or prevention in addition to above measures:

 

•Black tea (ACE inhibitor, reduces cytokines)

 

•Quercetin (possible ACE inhibitor, reduces cytokines)

 

•Pomegranate (ACE inhibitor)

 

•Proanthocyandin containig foods, supplements (ACE inhibitors): grapeseed extract, pinebark extract (pycnogenol)

 

•Turmeric (reduces cytokines). 1/4 tsp powder can be placed on tongue and swallowed with water

.

 

•Black pepper (reduces cytokines)

 

•Raw crushed garlic (reduces cytokines). For easy dosing, mix with tsp raw honey.

 

•Coconut oil (reduces cytokines)

 

•Echinacea (increases some cytokine activity but overwhelmingly reduces cytokine activity)

Assess carefully:

 

•Elderberry aka Sambucol (known to increase cytokines). I am avoiding.

 

•Astragalus (reduces activity of some cytokines, increases activity of other cytokines). I am avoiding.

 

•Olive oil (may increase cytokines). I will continue to use as needed but will use coconut oil for cooking/baking.

 

•Fish oil (may increase cytokines). I will continue to take significant amounts.

 

•Chocolate (ACE inhibitor but increases cytokines). I will use moderately;p

Cannel on preventing and treating H1N1:

http://www.vitamindcouncil.org/newsletter/h1n1-flu-and-vitamin-d.shtml

 

Randomized, placebo controlled trial shows D3 prevents and treats colds and flu:

http://www.ncbi.nlm.nih.gov/pubmed/17352842

Edited August 30, 2009 by cillakat

[AuntieM]

Wow, 50% reporting no fever? We were just in the doc's office this morning and she told us that the fever would be our clue, coupled with worse than usual cold-related asthma.

[cillakat]

Wow, 50% reporting no fever?.

 

Yes. This is a huge problem b/c it's the presence of a fever that moves a person along the algorithm to flu dx. Without that, they won't get the dx, estimates will be alarmingly low for # of cases and kids (and adults) will be out and about passing the flu on to high risk groups;/

 

K

[AuntieM]

Okay, so with no fever, and gastrointestinal distress an added symptom here, and the cases being mild, and doctors not testing for it, how in the heck can anyone know if they even have or had H1N1???

 

I guess that's exactly your point....

[Georgia On My Mind]

Wow!!!! Everything I have learned on my on researching since this thing started all in one place. Thanks heaps!!!!!

 

Why aren't you taking elderberry? Sambucal? You didn't mention n-acetyl cysteine or Oscillococcinum?

 

What about elderberry wine?

[cillakat]

Okay, so with no fever, and gastrointestinal distress an added symptom here, and the cases being mild, and doctors not testing for it, how in the heck can anyone know if they even have or had H1N1???

 

I guess that's exactly your point....

 

If you get sick, and have symptoms on the list, regardless of severity, assume you've had it. But yup, that's exactly my point. You won't know. So just say home for the requisite time period, be thankful for acquired immunity, do what you can to keep it mild, then move on with life.

 

:)

K

[cillakat]

Wow!!!! Everything I have learned on my on researching since this thing started all in one place. Thanks heaps!!!!!

 

Why aren't you taking elderberry? Sambucal? You didn't mention n-acetyl cysteine or Oscillococcinum?

 

What about elderberry wine?

 

Elderberry encourages cytokine production....which in and of itself isn't a bad thing. But since cytokine storm activity is a real possibility with this flu, I think it's best to avoid it. I'm not as worried about chocolate, fish oil and olive oil b/c the amounts needed for the elderberry cytokine inducing effect would be comparatively massive. Anyone eat enough chocolate lately to beat a cold or flu into submission?:)

 

Oscillococcinum is great.....but I can't find any evidence that it will help with H1N1 - esp since the symptoms are showing up so differently than typical flu....and homeopathy is so dependent on a good match between symptom and remedy. Sure can't hurt though! I love the stuff.

 

:)

k

[cillakat]

You didn't mention n-acetyl cysteine?

 

the jury is still out on NAC's effectiveness wrt lung issues (though it looks helpful for bipolar and depression....but probably not as helpful as other non drug tx). There are so many substances that work and work really really well and that have known cytokine and/or ACE inhibitor actions (likely more important with this flu than typical seasonal flu) so I decided to stick with those. NAC may or may not be helpful in this framework and there may be risks associated with it.

 

:)

K

[Donna T.]

Thanks so much for this info.! I'm glad to see you shared that the garlic needs to be raw. I have seen previous posts about the effectiveness of garlic and they all said to roast it or add it to soups. Heated garlic is useless.

 

I have been sick for a week. I only have (extreme) cold symptoms but they are the worse I've ever had. I never dreamed a cold could be like this. I ran a very mild fever for one morning but haven't had any stomach upset. I haven't been to the doctor. There has been H1N1 confirmed in our local school system.

[cillakat]

I never dreamed a cold could be like this. I ran a very mild fever for one morning but haven't had any stomach upset.

 

Yeah....I think you know: it's not a cold;p

 

Hope you feel better soon,

Katherine

[cillakat]

Okay, so with no fever, and gastrointestinal distress an added symptom here

 

This is exceptionally common. Many are having only this as the primary symptoms of H1N1 infection.

 

K

[NoPlaceLikeHome]

Wow, 50% reporting no fever? We were just in the doc's office this morning and she told us that the fever would be our clue, coupled with worse than usual cold-related asthma.

 

I am curious about this as well since my ds and I were both pretty sick in June with respiratory infections. He had a high fever and I had none. However, I did have severe respiratory symptoms and had to take 2 courses of prednisone for the first time in my life. I do have asthma-adult onset and not severe. It took me a full 8 weeks to recover from whatever we had which has never happened to me before. I am kind of hoping we had the swine flu already;).

[cillakat]

Okay, so with no fever, and gastrointestinal distress an added symptom here

 

This is exceptionally common. Many are having only this as the primary symptoms of H1N1 infection.

 

K

[cillakat]

I am curious about this as well since my ds and I were both pretty sick in June with respiratory infections. He had a high fever and I had none. However, I did have severe respiratory symptoms and had to take 2 courses of prednisone for the first time in my life. I do have asthma-adult onset and not severe. It took me a full 8 weeks to recover from whatever we had which has never happened to me before. I am kind of hoping we had the swine flu already;).

 

I hope you did as well!

 

Also worth keeping in mind is that Pertussis outbreaks are in full swing all over the place.....but a high fever is not typical at all of Pertussis - serious flu/cold symptoms illness aren't associated with pertussis, just serious fall out from serious coughing.

 

crossing fingers for you:)

K

[elegantlion]

Thanks so much for this info.!

 

I have been sick for a week. I only have (extreme) cold symptoms but they are the worse I've ever had. I never dreamed a cold could be like this. I ran a very mild fever for one morning but haven't had any stomach upset. I haven't been to the doctor. There has been H1N1 confirmed in our local school system.

 

 

:iagree: Thanks for the information. I've been sick for a week too. Low grade fever off and on. Thought I was getting better but now I have a fever again. Ds has it mildly. We've been no where all week. Yes, there are confirmed cases in our school system as well. :glare:

[Laurie4b]

What's the source of your information that says that people can have the flu without a fever? The CDC site says fever + another symptom.

[Perry]

What's the source of your information that says that people can have the flu without a fever? The CDC site says fever + another symptom.

 

This is old, but I don't believe the information has changed much.

 

Effect Measure

Swine flu: is there something unusual about the symptoms?

 

Category: Clinical • Infectious disease • Influenza treatment • Swine flu

Posted on: May 14, 2009 6:27 AM, by revere

A reader (hat tip River) sent me a link to a New York Times piece quoting a physician who recently saw swine flu cases in Mexico City. He called attention to what seemed like an anomalous clinical presentation of many cases. Besides a higher proportion of gastrointestinal symptoms (nausea, vomiting, diarrhea), Virginia Commonwealth infectious disease specialist Dr. Richard P. Wenzel was surprised that many cases, even severely ill ones, did not have fever:

 

Many people suffering from swine influenza, even those who are severely ill, do not have fever, an odd feature of the new virus that could increase the difficulty of controlling the epidemic, said a leading American infectious-disease expert who examined cases in Mexico last week. Fever is a hallmark of influenza, often rising abruptly to 104 degrees at the onset of illness. Because many infectious-disease experts consider fever the most important sign of the disease, the presence of fever is a critical part of screening patients.

 

But about a third of the patients at two hospitals in Mexico City where the American expert, Dr. Richard P. Wenzel, consulted for four days last week had no fever when screened, he said. (Lawrence Altman, New York Times)

High fever is indeed a characteristic finding of influenza illness, but many cases of seasonal flu are asymptomatic. After reading this I did a quick search of the literature to see what proportion it is. One of my virology textbooks says as many as half of flu infections are asymptomatic, while a recent systematic review of the literature of 56 different volunteer challenge studies estimates it to be about a third. In the same review, the frequency of fever in influenza A infections was about 40%, not too different from Dr. Wenzel's clinical impression. Since subjects in volunteer challenge studies are mainly young, healthy adults, this comparison is probably appropriate. The authors of the review conclude:

 

Pessimistically, viral shedding peaked rapidly, infections were rarely "typical," and symptoms or signs widely used for influenza case definitions (e.g., fever or cough) would be unreliable for identifying infectious individuals. (Carrat et al.,"Time Lines of Infection and Disease in Human Influenza: A Review of Volunteer Challenge Studies,"

American Journal of Epidemiology 2008 167(7):775-785

; doi:10.1093/aje/kwm375)

In other words, the absence of fever might not be particularly unusual. On the other hand, the relatively high prevalence of gastrointestinal symptoms is a worry:

 

Also, about 12 percent of patients at the two Mexican hospitals had severe diarrhea in addition to respiratory symptoms like coughing and breathing difficulty, said Dr. Wenzel, who is also a former president of the International Society for Infectious Diseases. He said many such patients had six bowel movements a day for three days. Dr. Wenzel said he had urged his Mexican colleagues to test the stools for the presence of the swine virus, named A(H1N1). “If the A(H1N1) virus goes from person to person and there is virus in the stool, infection control will be much more difficult,†particularly if it spreads in poor countries, he said. (NYT)

Gastrointestinal symptoms are also seen in H5N1 patients. The question whether there is intestinal infection and carriage is of importance. We know little about the distribution of appropriate viral receptors in tissues outside the respiratory tract, and some data suggests that flu virus can successfully make the passage through the acid environment of the upper g.i. tract. Is ingestion a possible route for influenza infection? Conventional wisdom says, "no."

But influenza is the surprise that keeps surprising.

 

 

 

[Laurie4b]

So what are the practical implications? Reading through these links, 1) a significant proportion have zero symptoms, so are still carriers, 2) if you have even one symptom, you should stay home for a week (What will be the effect on the economy/life in general if people with 1 mild symptom all stop working, etc when it may well not even be flu?)

[EmilyK]

I'm confused about this too. If we get what seems like a cold, or a stomach flu, but no fever, should we assume it is H1N1? I was assuming fever, joint pain, extreme fatigue would be a symptom. My kids had colds earlier this summer and I didn't think twice about it since they didn't feel particularly bad.

 

Basically, I'm confused about what sort of symptoms mean we should stay home and keep away from the grandparents. The more I read, it seems like any sort of symptom at all.:001_huh:

 

I'm not trying to be a naysayer, just honestly confused. Thanks for all the expertise!

[mirth]

•Echinacea (increases some cytokine activity but overwhelmingly reduces cytokine activity)

 

 

What does the above mean?

[Matryoshka]

•Fish oil (may increase cytokines). I will continue to take significant amounts.

 

I hadn't seen this one on the no-no list before - I was just going to add this to our diet (I've tried off and on for years but haven't found a kind my kids would ingest, but a friend just recommended one that looks like they'll take).

 

I see you're still going to be taking it anyway... you think I should go ahead and get the stuff? Is this more of a "maybe" it increases cytokines or "does"?

[elegantlion]

So what are the practical implications? Reading through these links, 1) a significant proportion have zero symptoms, so are still carriers, 2) if you have even one symptom, you should stay home for a week (What will be the effect on the economy/life in general if people with 1 mild symptom all stop working, etc when it may well not even be flu?)

 

I'm confused about this too. If we get what seems like a cold, or a stomach flu, but no fever, should we assume it is H1N1? I was assuming fever, joint pain, extreme fatigue would be a symptom. My kids had colds earlier this summer and I didn't think twice about it since they didn't feel particularly bad.

 

Basically, I'm confused about what sort of symptoms mean we should stay home and keep away from the grandparents. The more I read, it seems like any sort of symptom at all.:001_huh:

 

I'm not trying to be a naysayer, just honestly confused. Thanks for all the expertise!

 

That's where it gets tricky for me too. I'm sick but have not been around anyone visibly ill in the last two weeks. I have a compromised immune system (spleen removed) and generally avoid ANYONE who appears to be ill. I'll turn around in the grocery aisle if someone sneezes in front of me, stuff like that. So I came in contact with someone who was contagious at the time and now I've been sick for a week.

[cillakat]

I'm confused about this too. If we get what seems like a cold, or a stomach flu, but no fever, should we assume it is H1N1? I was assuming fever, joint pain, extreme fatigue would be a symptom. My kids had colds earlier this summer and I didn't think twice about it since they didn't feel particularly bad.

 

Basically, I'm confused about what sort of symptoms mean we should stay home and keep away from the grandparents. !

 

 

Pretty much. What symptoms would you normally go out and about with? Stay home with?

 

K

[cillakat]

I hadn't seen this one on the no-no list before - I was just going to add this to our diet (I've tried off and on for years but haven't found a kind my kids would ingest, but a friend just recommended one that looks like they'll take).

 

I see you're still going to be taking it anyway... you think I should go ahead and get the stuff? Is this more of a "maybe" it increases cytokines or "does"?

 

Well, it is complicated. It does slightly, but its also very VERY anti-inflammatory which is beneficial. I guess I see it this way: Elderberry fights cold/flu by increasing cytokines. Fish oil does what it does by many pathways, one of which is a *slight* increase in cytokines. I could take 3 tbsp of fish oil per day and it wouldn't treat my cold/flu like elderberry would;P........it's action via that pathway is exceptionally small.

 

I will continue to take fish oil......and eat some occasional chocolate. Occasional (small quantities) might mean daily:)

 

Katherine

[cillakat]

I'm confused about this too. If we get what seems like a cold, or a stomach flu, but no fever, should we assume it is H1N1?

 

Yes. But would it matter if it wasn't? You'd still separate yourselves from others anyway....get some masks so if you have to go out while sick, you can put them on the sick ones....

 

:)

K

[Matryoshka]

I will continue to take fish oil......and eat some occasional chocolate. Occasional (small quantities) might mean daily:)

 

 

Hey, there's no way I'm giving up my daily dose of dark chocolate! :D

[EmilyK]

Thanks for the replies. If we have a fever, we stay home including for a day afterwards. But -- and don't shoot me -- I just don't think of colds as that serious. So earlier this summer my kids had colds, and no we didn't stay inside/away from all others for the 3 weeks (combined) they had stuffy noses. (They are 7 and 10, and old enough to cough in a sleeve, blow noses, wash hands etc). I guess I have historically drawn a distinction between what feels like a simple cold (no or little fever, but congestion and possibly cough at the end) from anything that involves a real fever, muscle or joint aches, real fatigue. With both I would stay away from someone with a compromised immune system, but I wouldn't cut out going to a park or a class/lesson when one of us has the former, especially if feeling fine, just stuffy.

 

And this is just for me (a healthy person) -- I don't particularly avoid sick people, and don't blame others when I get sick. As a healthy person -- so this would *totally* not apply to someone with a compromised immune system -- I don't worry about "normal" germs, and just figure it is up to me to get enough sleep and do whatever I can to boost my own immune system (which is one reason I'm clicking on these threads -- figuring out prevention).

 

But I'm wondering if 1) my "normal" rules are wrong (I still can't figure out how we'd keep the adults in isolation when mildly sick, since work and errands need to be done, and colds can linger, but I could keep the kids home more) and/or 2) if this season because of H1N1 (whether overreaction or not) it is important/advisable to keep away, even when it seems like a cold, and we're on the tail end.

[HappyGrace]

Thanks, Katherine. I've been reading up on elderberry/cytokines and had decided against it. I was about to research for exactly what you've posted here! I trust your info on D; have felt like a new woman since taking it, and would not have known I was dangerously low if it weren't for your previous posts. So I was glad to have this new info w/out having to do the legwork myself-thank you! :001_smile:

[Pretty in Pink]

But I'm wondering if 1) my "normal" rules are wrong (I still can't figure out how we'd keep the adults in isolation when mildly sick, since work and errands need to be done, and colds can linger, but I could keep the kids home more) and/or 2) if this season because of H1N1 (whether overreaction or not) it is important/advisable to keep away, even when it seems like a cold, and we're on the tail end.

 

When my kids are sick, I keep them home. I have four kids so that may mean several weeks without activities. Sometimes it sucks. I will do my shopping and run my errands in the evenings and/or on weekends when dh is available to keep the sick ones. If one of the children has an activity but another is ill then I either try to find a ride for my child or I drive them and wait in the car with the sick child.

 

I used to take them out when they just had little cold but then my second child developed asthma. A little cold is no joke for him. We are careful when we go out, washing our hands frequently and such, but I can't isolate him, ya know? I really appreciate it when others keep their sick children home.

 

I know I've seen pages and pages of threads about this topic before on this forum so you might be able to search it if you are interested.

[EmilyK]

OK, thanks. I hear what you are saying.

[Renee in NC]

This is exceptionally common. Many are having only this as the primary symptoms of H1N1 infection.

 

K

 

We think that we have it here with this weird set of symptoms. My mother and 11yo had sore throats, cold symptoms, etc. She also had the GI symptoms and the aches, extreme fatigue, etc. I have the GI issues and extreme fatigue and aches and pains. My stepfather just has the GI issues and feels bad. The other dc have complained of sore throats, stomachs hurting, etc and needed more sleep than normal.

 

We are *hoping* this is H1N1 so we can have immunity this winter!

 

ETA: My mother and I have also had the alternating hot and cold feelings as well. It feels like I have to flu, but no cough or runny nose.

[Laurie4b]

Pretty much. What symptoms would you normally go out and about with? Stay home with?

 

K

 

I would not stay home with symptoms that could well be cold or allergy: sore throat, runny nose, etc.

 

We normally use typical health guidelines (like those used by schools and day cares): stay home if you've had a fever, vomiting, or diarhhea within 24 hours.

 

I really am having a hard time seeing the necessity staying home with symptoms other than the ones above (or a typical flu pattern of aches, respiratory issues,etc.) just because it *might* be the flu. In the blog Perry cited, for instance, there was a significant percentage of people with zero symptoms, who had the flu. So given the absurdity of staying home with no flu symptoms (though you actually could have it), I'm having a hard time following the practicality of the logic to stay home if you have any flu symptom (such as a runny nose, mild sore throat, etc.) Those symptoms could be indicative of seasonal allergies, a cold, etc. I've also read that the fewer the symptoms, the less virus is shed, making the person less contagious anyway.