H1N1 can't be diagnosed in a GP's office (WebMD info)?

Factual Questions
21

Fascinating post, USC Diver, and very much appreciated here. I came down with flu-like symptoms two weeks ago today, and being 6+ months pregnant and with an underlying condition (asthma, albeit mild), I was immediately placed on Tamiflu. I needed two of my doctors’ and Qapdop’s reassurance it was better for me and baby to take it than not–a pharmacist had told me it was not recommended for pregnant women. I’m glad I did.

Anyway, the following Friday (10/9) I was in my GP’s office getting a breathing treatment. I expected to feel sick Sunday (10/4) and Monday, but actually felt worse by the end of the week. The cough sucked. Anyway, while I was there, I mentioned how my OB was sure I had H1N1, and my GP went ahead and tested me. My results came back negative. My OB (who I saw Thursday 10/15) was completely dismissive of the results and adamant I had to have had H1N1, quoting similar things USC Diver did–the health department was no longer recommending testing, it’s really the only flu that offices are seeing, and my symptoms were fairly typical. He said, repeatedly, it had to have been a false negative, and he questioned the accuracy of the test. When I got home and did some Googling, I found the accuracy was pathetic–something like 40-60% if the test is done early in the illness. Six days after symptoms appear? Ummm…yeah.

Considering how brutally this thing hit me, I’m inclined to believe my OB that the H1N1 test was a false negative as well. I ran a low-grade fever (99.5-100.1) for 11 days. Eleven days! I have never experienced that with any flu, ever, including a few I had while pregnant with my first. I was wrecked and couch-bound for eight days, and it would have been longer if I hadn’t dragged myself off of it to go back to work (promising my doc I’d go straight home and rest). The only other time in my memory something has knocked me on my ass that long was when I had pneumonia 15 years ago. Here I am, two weeks later, and I’m still ridiculously easily exhausted. Showering and getting ready in the morning often has me reaching for my inhaler, my heart racing, and my body pouring sweat. Whee!

Which leads me to a branch-off question for our resident MDs: My OB urged me, repeatedly, to be seen by a pulmonologist. His urging lessened some when he listened to my lungs–they’re clear, and have been this whole time–but he’s concerned I still have feelings of pressure and mild respiratory discomfort. I still have a slight cough that to me seems like nothing, and I still feel like I can’t get a satisfying breath at various points throughout the day, but a pulmonologist seems like overkill. Clear lungs? Scoring 100 on pulse-ox? Come on. Then again, if I hadn’t listened to my OB before in his urging to call him the moment I felt various flu-like symtoms, I may have been worse off. Really? A pulmonologist?

(BTW, my GP would have to make the referral. I’d need to call and tell them my OB is insisting on it. These two offices do not agree–the GP thinks I just had a “virus,” the OB is adamant I had H1N1. It may be interesting saying, “Um…I know you don’t think this is necessary, buttttt…”)

And to the OP bordelond–I hear you on the H1N1=EVERYBODY PANIC!!!1!1 Being pregant and having those words echo in my family’s ears resulted in some well-controlled-but-still-obvious freaking out. Still, again, it’s good in a sense because I didn’t take it as seriously as they did, and if I had pushed myself the way I wanted (before my OB put on his “That’s an ORDER!” face), I may have been in a scarier place. I’ve been saying a lot of “Yes, sir” and “Yes, ma’am” and keeping my reactions internal.

22

It’s doing a number on us in Hokkaido right now. There’s an average of 55 flu patients per medical facility in Sapporo. Due to the system here there are of course the huge general hospitals but there are also huge numbers of smaller clinics. So that’s a large number.

Here the schools’ normal flu rules are that when more than 10% of a class are out with diagnosed influenza then the class closes for five days. They have kept this rule in place and at the moment in our town there are five schools either completely closed, with school years closed, or single classes closed. I think this is quite a sensible policy if the kids are actually kept home, as it does seem to reduce the wave of flu at least temporarily.

My elder son got it a couple of weeks ago and he was quite ill. It was at least as bad as normal flu.

I wouldn’t wish it on anyone and with the vaccine arriving so late, quarantine and hygeine measures are the only way the spread is going to be reduced.

23

Ruffian, why did your OB want you to see a pulmonologist? Only because you have asthma? Or were there other reasons.

Most family docs can manage asthma in pregnancy. However, if the asthma gets tricky (as in suddenly poorly controlled) I’d recommend the patient see an allergist. Pulmonologist would be my second choice.

24

Qadgop, it wasn’t my asthma (which is really mild; I can count on my fingers how many times I need my inhaler in an average year), at least I don’t think. I believe it was just concern about this supposed H1N1 flu virus going to my chest and my complaints of pressure. My GP last Friday (after my breathing treatment) recommended I use my inhaler every 4-6 hours, as opposed to “when I need it,” and now I use it about 1-2 times a day.

It seems normal to me to have a virus that leaves me with chest congestion as it slowly fades, but he was more concerned. I assume this is because of the danger of viral pneumonia in some preggos when they get H1N1, but again, my lungs are clear. Meh. I will say this is odd in that I have not had an illness go to my chest in a long, long time; they almost always go to my sinuses, if anywhere.

25

On TV , doctors said the difference was Swine flu included a fever. Otherwise they were indistinguishable.

26

Both H1N1 and the seasonal flu cause fevers. There’s no reliable way to distinguish H1N1 from the seasonal flu based on symptoms alone.

27

The distinction between fever and no fever is that a flu-like illness without a fever is nothing to worry about. There are multitudes of low-severity colds and other flu-like viruses that aren’t influenza proper, but have the same sort of cluster of symptoms. Most of the standard cluster of flu-like symptoms really aren’t from the infection itself, but rather are side of your immune response – thus why the symptoms are so common.

So I believe the distinction that Gonzomax saw on TV was probably more that anybody who thinks they have the flu, but doesn’t have a fever, has nothing to worry about and doesn’t need to see a doctor. (Unless, of course, it doesn’t clear up in a few days, or there are other more serious symptoms…)

28

Given the bolded, I know from experience that many cases of H1N1 are really, really mild, symptom-wise. Anyone know why the same strain comes on to Patient A as quick-death ebola, and Patient B as sniffles? Especially when Patient A is an apparently healthy 30-something, and two Patient B’s are toddlers?

29

Figure that one out, and you too can anticipate a Nobel prize. Or at least a nomination for one. Lots of hypotheses out there, not a lot of facts.

30

Not making light of anything, but sometimes life really does feel like D&D. It’s like sometimes people just roll a critical fail on their save vs. disease roll. :frowning: No reason or rhyme, just a bad turn.