Since my article one week ago, we are seeing a rapid rise in H1N1 influenza cases (formerly known as swine flu but it is more accurately swine/avian/human flu). One young boy with a history of asthma recently caught this mean tail germ. I treated him with Tamiflu as well as his mother with preventative doses of Tamiflu. Mom also has asthma as well as diabetes. I suggested to mom that other family contacts may want to see their own doctor about getting preventative Tamiflu as well. I saw her husband a few days later. He was cursing his own primary care physician because he wouldn’t give him Tamiflu. He was thinking of changing to a new doctor.

The CDC (Center for Disease Control) currently recommends the following regarding H1N1 flu.

The CDC has left room for a doctor to decide on his or her own treatment for new flu cases and those exposed to flu. In general, high-risk patients should be treated with anti-viral drugs (Tamiflu or Relenza) or given them as prevention if there has been clear close contact exposure. People at high risk of complications or even death from flu have some baseline health dysfunction. You can’t breath right such as in long term cigarette lovers with emphysema or any person with asthma. You’ve got a bad ticker in the sense you have heart disease. Examples would be heart failure or heart attacks in the past. You don’t urinate normally (kidney failure). You’re liver is messed up (booze-related cirrhosis). Your blood is unusual (sickle cell disease). You’re full of sugar (diabetes). Or your immune system stinks (cancer, HIV).

Other categories of patients who may merit treatment for flu or preventative medications for flu include women with a bun in the oven (pregnancy), people who live in nursing homes, children under age 5, as well as adults over 65 years of age.

My partner Dr. William Carr surveyed infectious disease specialists at two rival institutions Duke and UNC Chapel Hill. Blue Devils and Tar Heels may despise each other when it comes to basketball, but scientifically are generally on the same page as the above CDC recommendations.

Healthy people are felt to be able to fight off the flu without anti-viral medications. If you have no medical problems, the likelihood of you becoming severely ill or dying from the H1N1 flu is very low. In fact, over use of Tamiflu and Relenza can lead to the virus becoming resistant to these drugs faster. So to the husband described in the first paragraph, I explained to him that his doctor did the right thing. Since the husband is healthy and has no symptoms, he doesn’t need to have preventative Tamiflu. The man said that this was exactly what his doctor told him, but thought he was just being cruel. Satisfied that his doctor isn’t a quack, the dad is once again a loyal patient.

So in short, if you are generally a healthy person between the ages of 6 and 64, don’t get the flu. Because if you do, most of us doctors will just let you suffer. Although you might feel like you’re dying when you have the flu, most likely you won’t.