Monday, November 9, 2009

H1N1, Tamiflu, and Pregnancy

I wrote a long, thoughtful, and, let's face it, wonderful post all about H1N1 and pregnancy. And then somehow I managed to delete it before it was posted. It happens to everyone, but that doesn't make it less annoying.

The gist of the post was concern over following up on the use of Tamiflu during pregnancy. Due to a number of factors, pregnant women should be concerned about flu. Women are much more likely to suffer complications and risk death due to flu during pregnancy, and Tamiflu may be a life-saving drug. Conversely, Tamiflu is a Category C drug in pregnancy. To be classified a Category C drug, the drug must either be untested in pregnant women or have had concerning animal studies. In the case of Tamiflu, some research has demonstrated skeletal anomalies in fetal mice. How does this translate to humans? Perhaps it doesn't. Oftentimes those studies use ridiculously high dosages. Mice physiology clearly differs from human. And the timing of the medicine is likely to make a difference, with the higher risk during the first trimester as opposed to later in the pregnancy. 

This brings up the ethical concern of a woman's right to chose her treatment. If a woman refuses treatment could she be charged with fetal endangerment? Or if she did accept treatment and had a negative outcome, could she (or her health care provider) be charged with the same thing?

There is an urgent need to follow up with women who have taken Tamiflu during their pregnancies to establish the safety of the drug. I would not want to see a woman decline what might be a life-saving intervention for fear of injuring her fetus -- I have already heard of women who have made this choice and I have heard of OBs who refuse to write the prescription for pregnant women. We must ensure that the science keeps up with the H1N1 outbreak, at least as much as possible.  

Tuesday, November 3, 2009

The Great Flu Shot Chase

I meant to post this when I first heard it on NPR -- an excellent commentary on the problems with the recommendation to get seasonal flu shots combined with the lack of access to the vaccine.

Infected with H1N1

I have spent the last 13 days getting to know our friend H1N1 personally. While I have said many times this is a mild to moderate illness, I managed to have the moderate bout. More than once I thought I would end up investigating myself as a hospitalized case. Fortunately that did not happen, but I did end up with three separate trips to the doctor.

The morning after a sudden onset (7pm on a Thursday night, scratchy throat and a fever of 101.3 – it was so sudden I remember), I began a course of Tamiflu. And that day, despite fatigue and chills, I felt like I would have a quick recovery. The following morning, with the start of the second day’s dosage, I threw up for three hours. This is one of the side effects of Tamiflu. We often see children hospitalized due to dehydration with the flu, occasionally brought on by the side effects of the drug. I stopped taking it, knowing full well the potential for breeding drug-resistant virus. At that point though the cure was making me sicker than the illness, and frankly I am a poor patient when it comes to drug compliance anyway.

In the end I wished I had stuck with the Tamiflu. By the following day my throat was so raw I thought perhaps this was a misdiagnosis and I actually had strep. I went to the doctor. No strep, just lots of post-nasal drainage. So much post-nasal drainage that I could not sleep. I felt I was drowning on all the draining, and could not lie down. I created an awkward pallet of pillows on the sofa and tried my best to sleep sitting up (no, I don’t own a recliner, and yes, I know that would have helped). The fever came and went. I choked on snot. I threw up a lot. I was generally miserable. I ended up back at the doctor again and got some high powered decongestant. Only then everything was so dry I coughed for the dryness of it. I took a lot of antibiotics to ward off early signs of pneumonia, and steroids which always make me feel like air is seeping through my chest walls – easier to breathe but unpleasant. I also took multivitimins, tried a grape seed extract nasal spray (pretty much worthless), and drank a terrible tasting cold tea which helped quite a bit. All in all it was a terrible experience which I do not recommend.