Influenza can make you critically ill

The night before I was leaving for a three-week medical mission trip, I was called urgently to the ICU to see Rachel (name altered), a previously healthy woman in her late 40s, slightly overweight with dirty blonde hair. She had started a new job as a customer service agent. Rachel was the sickest patient I had seen in months, and I could not figure out what was going on.

A week before her hospitalization she had fever, abdominal pain, headache and cough, and then it quickly developed into severe shortness of breath and pneumonia. All her preliminary tests for the flu and common causes of pneumonia were negative. Within 24 hours of hospitalization she required a breathing tube and the ventilator settings were piped up to the maximum: 100 percent oxygen with highest pressures. And yet, she was still not getting sufficient oxygen to her heart and brain.

I placed her on three antibiotics to control her infection, the pulmonary doctor did a bronchoscopy to obtain culture from deep inside her lungs, and the nurses tended to all of her needs to keep her alive. As I stood with her somber husband and two tearful teenage daughters outside the glass doors of the ICU room, I described the grave circumstance. “I am not sure if she will make it, but we will do our best,” I told them.

Overnight, Rachel’s condition worsened. A heart surgeon was called and a last ditch effort was made to provide her oxygenation with extracorporeal membrane oxygenation. ECMO provides temporary oxygen to patients whose heart and lung are severely damaged. Often it is used as a heart-lung machine during cardiac bypass surgery.

The cause of such sudden and severe pneumonia was unclear. I asked the family questions: if Rachel had travelled and acquired MERS, Middle East Respiratory Syndrome. Had she been in contact with any animals or persons who were severely ill, or been exposed to any environmental hazards at her new job? “No,” her husband replied to all of my questions.

Then, as I was boarding my flight, the laboratory called me. The bronchosopy test had shown Rachel had influenza A, the seasonal flu. The previous two tests had been false negatives, but the more definitive bronchoscopy test had come positive. She was already on multiple antibiotics and Tamiflu, yet she was still critically ill.

During my trip in the urban slums and villages of India, as I visited patients who had their lungs ravaged by another germ, tuberculosis, I wondered if Rachel had survived. Each day in the world nearly 4,000 patients die of tuberculosis, a disease, which is entirely preventable and treatable, if proper precautions are taken. And yet time and time again we fail.

While I was gone, my partner cared for Rachel and updated me. By Christmas Eve, a week into her hospitalization, Rachel was off the ECMO, and by New Year’s the breathing tube was removed.

The day after I came back from my medical mission trip, I saw Rachel in a regular room smiling and comfortably breathing. Her hair was less disheveled, and she apologized for not remembering who I was. She was preparing to go to the rehabilitation hospital where my wife, who is also a physician, would care for her.

We don’t think of flu as a life-threatening illness in otherwise healthy young or middle age adults, yet it is. In a bad flu season as many as 50,000 deaths may occur due to flu related illnesses.

The vaccine, though it is not perfect, is helpful. Last year’s vaccine was estimated to be 56 percent effectiveA recent report estimated that last year flu vaccination prevented 6.6 million flu-associated illnesses, about the population of the state of Arizona. Also, vaccination prevented 3.2 million medical visits, and 79,000 hospitalizations, the number of fans in a full NFL stadium.

Unfortunately, 50 percent of the population is not vaccinated for the flu, making themselves and others around them vulnerable. Rachel told me that she just had not gotten around to getting the vaccination this year but, “I am certainly getting vaccinated from now on.”

Manoj Jain is an infectious disease physician and contributor to the Washington Post and The Commercial Appeal.  He can be reached at his self-titled site, Dr. Manoj Jain. This article originally appeared in The Huffington Post.

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  • Kristy Sokoloski

    This is scary. And even for as scary as it is the anti-vaccine movement continues to insist that people should not get vaccinated not just from vaccine preventable illnesses that can occur in childhood such as measles, mumps, etc but also the flu. I have read both sides of the issue about vaccines and have had my own concerns about vaccines for medical reasons. However, by getting them under the watchful eye of my doctor I did ok. The only time I did not get my flu shot at the doctor’s office was back at the beginning of Nov (instead of Oct) because their office did not have the supply yet so had to do it at my pharmacy.

    I was always afraid to get a flu shot because like with other vaccines the medical concerns. And I figured “Well, I think I would rather have the flu than have the shot.” However, when my relative had to go to the hospital back last Jan one of the things she was diagnosed with was pneumonia. Now whether she had the flu before that occurred I don’t know. They found she had some additional health problems as well. She was in the hospital for 1 week but even before that hospitalization my doctor had insisted that I get a flu shot. Well, as it turned out I also needed that flu shot because I was going to go to Nursing School. But when I saw my relative get sick I knew that from then on I would get a flu shot. Then I understood why my doctor insisted that I have the flu shot. Whether or not I get back to Nursing School is another story for another day and another time, but my lesson is never to go without a flu shot again because if I ever get the flu again without it I could become one of the many statistics that happens as a result of the flu each year.
    The anti-vaccine movement keeps on getting stronger as the months go by and I have no idea what can be done to get them to let go of their tight grip. I know they have concerns about vaccines, but the concern about the number of people dying from complications from vaccine preventable diseases including the flu is of even greater concern to me. All vaccines like all medications and other treatments have risks and benefits, and each person must weigh each of those carefully. And then make the choice from there as to do what’s best for them. However, they must understand that healthcare professionals are just trying to do their jobs as well: protect the health of everyone in the community.

  • John C. Key MD

    Indeed it is scary. A young man in my community just died with a similar picture; I doubt he had all of the services described by Dr. Jain. I tend to not worry much about the flu although I always get and give immunizations. An important reminder.

    • querywoman

      Dr. Jain apparently guessed the right magic potions for her and provided the other proper support.

  • querywoman

    I just did 2 days in the hospital for pneumonia. I know it started out as flu, though the nasal swab was negative. I got 8 days for pneumonia in late 2012, similar, but much worse.
    I have an egg allergy and had one flu shot once with a terrible reaction. I am going to consider the new eggless flu shut.
    I know that a negative nasal swab does not mean I don’t have another strain of flu.

  • Kristy Sokoloski

    And I would agree with that. Especially as it relates to the Anti-vaccine movement.

  • Kristy Sokoloski

    And there is 50% of the population that agrees with me that the benefits outweigh the risks.

    • querywoman

      Chiked and Kristy, we do live in a free country.

  • querywoman

    If she was “slightly overweight,” then she had some fat to fight with, didn’t she? I assume she lost quite few pounds during that type of illness, didn’t she?
    Would a thinner type have been as likely to survive?
    That’s one of the purposes of fat!
    I’m recovering nicely from my own short apparent flu to pneumonia illness.

    • SarahJ89

      I’m not a doctor, don’t play one on tv. I am, however, fat. And I can tell you that lugging around 30 pounds of dead weight is a drain on your body. It has no magic powers and my guess is that any weight you lose from illness is at least half muscle mass–the stuff of which one’s heart and intercostal muscles are made.

      So no, I would not want to enter a serious illness lugging around a bunch of fat. (Which, I can also assure is *really* hard to lose when you’re well enough to walk to the refrigerator.)

      • querywoman

        The idea that fat is inherently evil is just some human-made up idea. Lots of fat is hard to move around.
        Most Americans are “fat” by current guidelines and most live long productive lives.
        Fat lung cancer patients tend to have better outcomes. My mother started out fat and the weight loss hit. A thin person with the cancer weight loss would have died sooner of starvation.

        • SarahJ89

          I never said fat is evil. But it is uncomfortable. It is dead weight. For me, the trade off is between “Gee, I might be able to live off my fat a few weeks longer if I get cancer” and “Hey, I can enjoy cross country skiing so much more today if I’m not herring-boning that extra 30 pounds up that hill.” No contest for me. I’ll take Door #2, although it gets increasingly harder to pry it open as I age.

          • querywoman

            It probably depends on what size you start out with.
            But, flu causes weight loss.
            Exercise really helps. It can be mild, like yoga. Also walking.

          • SarahJ89

            I walk a lot. It definitely helps. This winter has been exceedingly icy underfoot, to the point where I’m starting to understand why little old ladies are afraid to go out in winter. One fall…

  • querywoman

    It does tell us he really looked at her as a person. He’s Indian, a little darker.
    I didn’t know what he meant, since “dirty blonde” is a hair color. He apparently meant disheveled or messy.
    I’m very pale. People of all skin colors get bacterial and viral diseases.
    My own skin color is relevant in some of my illnesses, like my skin disease. I get deathly pale when I’m sick.

    I laughed when a Vietnamese nurse told a doctor’s nurse on the phone that I looked kind of pale. I told the nurse, “She’s Vietnamese.” So is the nice young doctor.
    When we hung up, I looked at the Vietnamese nurse and told her she looks kind of pale to me. She’s a little anemic, though. She actually has dark brown, not black hair. Cute little Asian face. She’d love to be able to fatten up her small Asian body, but she has a cute little figure.
    I’m really glad Dr. Jain came back to a much improved patient. He also seemed thrilled that she has wife’s patient now.

  • querywoman

    Now I’m on a quest for my own holy grail: trying to find the new Flucelvax eggless flu shot. I’m capable of doing the hunt on my own, but I’m starting to wonder why a certain doctor, a lung doctor, isn’t responding.
    He only has one shot in his office.
    I’m seeing him Friday.
    I am wondering if his familiar with the new Flucelvax. I know 2 other good lung doctors.
    Opinions?