I wrote this while recovering from a bout of the flu. I mean the real flu, not a cold. Flu is a cold on steroids. You can die from flu. Once you’ve had it, you never want to experience it again. It is enough incentive for me to get my flu shot annually.
Story: Dr. Richard T. Bosshardt Illustration: Josh Clark Now
I know how Fay Wray felt as she watched helplessly from a ringside seat as King Kong battled the horde of World War II-era biplanes, each trying to destroy the other. This past weekend, I was Fay Wray. In place of a gargantuan ape, my King Kong was a member of Orthomyxoviridae, a family of viruses that contains all the strains of influenza. The horde of biplanes was my immune system, which flung itself against the invader with no less determination and, ultimately, fortunately for me, success.
All I could do for several days was lay around as a helpless bystander and, at times, semi-conscious as the battle raged inside my body. If I am honest, there were times it was tempting to just toss in the towel and succumb to the misery and an untimely demise. “But he was so young and virile,” I could hear the mourners saying at my memorial service. “Yes, the world lost a prince, a real peach,” another would opine. Fortunately, as this musing on the weekend testifies, I survived to write again.
The hostilities began as a light tickle in my chest producing a mild, dry cough. I didn’t think much of it, perhaps just a little bit of hay fever or perhaps one of the mild viral “colds” I get once or twice a year. Within 24 hours, however, the cough had escalated with bouts of hacking so intense and prolonged that I half-expected to pop a rib or cough up a chunk of lung. I think I may have done both. Within 48 hours, I was laid out, feverish, aching, coughing, and contemplating whether death might not be a reasonable, even desirable, alternative. Everything hurt: my muscles, my skin, even my hair and teeth. All of this due to an organism so small it would take 3,000 of them laid end to end to span an inch. Influenza was a potent David to my overmatched Goliath.
Viruses are interesting organisms. While clearly living things, they are incomplete because they require a host whose cells they hijack. They use the cells’ genetic machinery to replicate themselves. In the process, killing the cell. Kill enough cells and you kill the host. Whether influenza or HIV/AIDs, all viruses behave pretty much the same way. Although we have a number of anti-viral medications, whether we recover, or die, still depends largely on the competence of our immune system. This invaluable system throws white blood cells and lymphocyte “killer cells” against the invader. These cells sacrifice themselves in wave after wave of assaults where untold hundreds of millions perish. Eventually, if all goes well, our killer cells overwhelm the invader, internal peace is restored, and we recover. Ironically, it is the vigorous response of our immune system that produces many of the symptoms associated with the flu: fever, aches, malaise, outpouring of mucous, and more. People with incompetent immune systems often don’t become very symptomatic; they just die. One unwanted consequence of the stress to our immune system is making us more susceptible to bacterial infections. In my case, this resulted in a severe bout of bacterial bronchitis, heralded by a change in my cough from non-productive to productive of thick, yellow phlegm. Yellow phlegm is due to its high content of dead white blood cells, more commonly referred to as pus. Unlike flu, for which there really is no medical cure, bronchitis requires antibiotics.
When to give and when to withhold antibiotics is a decision requiring experience and sound clinical judgment. Unfortunately, too many practitioners throw antibiotics at every viral illness. This is not only ineffective but also part of the reason we have created new strains of bacteria resistant to nearly all available antibiotics. We will rue the day we began using antibiotics indiscriminately both for people and in commercial applications.
I am now on the downslope of this particular bout of flu. I finished a course of steroids, am on a steroid inhaler, and antibiotics. I feel like a living cauldron of pharmaceuticals. I resent having to take them but I am glad to have them. Had I been more astute, I would have begun a course of Tamiflu (Oseltamivir) as soon as it became obvious this was not a routine cold. Like most physicians who treat themselves, my doctor was less than astute.
My recovery is a foregone conclusion, but the cost has been high. A week of my life was miserably spent and is gone forever, including three days of missed work, and I know it will be at least a couple of weeks before I have close to normal strength and stamina. I feel like a toy grabbed by a dog and shaken half to pieces—fragile, listless, lacking energy, and trying to remember what normal feels like.
I am not one to run in to my physician at the first sniffle or tickly throat and I do not advocate others doing this. I do recommend you notify your doctor when things take a decided turn for the worst so he or she can tell you if you need to come in or not. As I noted in a prior issue of this magazine, I look at urgent care centers with a jaundiced eye. I am not convinced they are reliable.
(As I wallow in my misery, I cannot help but muse about people who never know a day of truly good health in their adult lives, people I see every day. Too many bring this on themselves by the choices they make, but a lot of unfortunate individuals just got the short end of the stick genetically and physically and live their lives in daily survival mode for reasons that are not their fault. My prayers go out to them. I know I won’t take my health for granted for a long time.)
- If your “cold” seems unusually severe or sudden, call your doctor. It could be the flu. Tamiflu can shorten the severity and duration of the flu but must be started within 24 hours of onset of symptoms.
- Take the flu seriously. Even healthy people can die from the flu.
- Get your annual flu shot at the start of flu season. Even though it does not guarantee protection (some years are better than others), it can protect you from the most likely strains in a given flu season. The risks of the vaccine are less than the risk of the flu itself.