<p>^^if we all start taking Tamiflu now, soon there will be strains of flu that are resistant to it.</p>
<p>mimk6–speaking as a Mom here, I would be pretty agressive in being sure my daughter was being adequately evaluated – and not take a telephone evaluation from someone who does not know her for an answer. I actually once published a paper on “wellness bias” when physicians do phone triage – they are so used to talking with people who are not sick, that they tend to assume that almost everybody is not sick – discounting symptoms that might otherwise be worrisome. I’d be willing to bet that this doctor has not seen a young patient with the flu in the ICU on a ventilator and is basing his response to what he has seen in years of experience with the seasonal flu. In this case, your daughter’s underlying asthma/respiratory symptoms and immunosupression (although you’ve not given details on this) would be red flags that one should have a low threshhold for in-person evaluation. Particularly, your report that the physician didn’t provide instructions for follow up does not sound appropriate. You say that your D’s regular physician should be in today – at the least, I would be sure she talks personally with him about her symptoms and whether she needs to be evaluated. If she’s getting worse I would encourage her to be seen in the ER and would GLADLY insist on paying the 20% co-pay. I would tell her she was doing it for MY peace of mind, if that made it easier. Lest you think the lack of fever means it is not flu or not serious, read this: <a href=“http://www.nytimes.com/2009/05/13/health/13fever.html?_r=1&em[/url]”>http://www.nytimes.com/2009/05/13/health/13fever.html?_r=1&em</a>
Also – just yesterday, the CDC recommended prompt treatment of patients with underlying medical conditions – not even relying on rapid flu tests, which have a high false negative rate, because the consequences can be so devestating in young people:</p>
<p>Doctors Told to Give Flu Medicine Promptly
By DONALD G. McNEIL Jr.</p>
<p>Federal health officials warned doctors on Tuesday not to rely on flu tests to make decisions about whether to treat sick patients with antiviral drugs like Tamiflu.</p>
<p>“The time it will take to get the lab test back shouldn’t be waited for,” said Dr. Anne Shuchat, director of immunization and respiratory disease for the Centers for Disease Control and Prevention. “If you have a person who is severely ill or a person with risk factors like pregnancy, asthma, diabetes, children under 2, and you suspect flu, we recommend any antiviral medicines be given promptly.”</p>
<p>Too many doctors have been delaying treatment, not realizing that flu tests are notoriously inaccurate, Dr. Shuchat said.</p>
<p>By some accounts, when a rapid flu test indicates that a patient does not have the flu, it is wrong 40 percent of the time. Even more sophisticated tests often go wrong because many doctors and nurses are unskilled at taking nasal swabs. (A correctly done swab “feels like the Q-tip is going into your brain,” one expert said.)</p>
<p>Linke to full article: <a href=“http://www.nytimes.com/2009/10/21/health/policy/21flu.html?pagewanted=print[/url]”>http://www.nytimes.com/2009/10/21/health/policy/21flu.html?pagewanted=print</a></p>
<p>Posted yesterday on flu.gov:
[CDC:</a> 2009 H1N1 Flu Continues to Impact Young People](<a href=“Influenza (Flu) | CDC”>Influenza (Flu) | CDC)</p>
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<p>mim - I hope your daughter can be seen today.</p>
<p>I really don’t even understand why a doctor would NOT treat right away. There is no danger in treating, and every reason to treat your daughter, in particular. I was joking about my D earlier, but I was terribly worried til I got her to go to the doc and heard the cough medicine was working (cuz of pnuemonia)…A regular doc would just treat her, I think. Maybe she could just go there? I’m sorry. This sounds really worrying. Good luck.</p>
<p>poetgrl - how’s your daughter and roomie doing?
Your post did make me laugh. reminds me of the time I visited my oldest when her roomie had mono, she was from Maine so I drove down to check on them. The room was a disaster and there were used water bottles everywhere, some were half full, others nearly empty. I started throwing them out and was told - we reuse them! Argh!</p>
<p>Well, I’m sure her roommate is feeling a lot better without a mask on. That’s for sure. D is doing better. She was having trouble sleeping, but now that she has the cough syrup she can sleep. The doctor was pretty horrified she hadn’t come in earlier, but she isn’t much of a one for slowing down. I can’t recall who on the board recommended Grandma’s Chicken Soup, but thanks. I ordered that for the two of them and it should get there this morning. I hope everyone else’s kids are able to stay healthy! :)</p>
<p>Oh, and the water bottles! Once on soccer roadtrip, I walked into one of the girls rooms, and they were all just drinking each other’s gatorade. Nobody even knew whose was whose. They sleep 4 to a room on this trips! Yuck.</p>
<p>JustaMom – I sent your post along. She’s not picking up the phone right now and I’m going into an all day workshop in an hour but I told her if she’s any worse at all, to get to her doctor today. She didn’t seem worse last night.</p>
<p>I really hope she’s sleeping! I’m sorry you have to be worried from a distance. :(</p>
<p>Another aggravated mom here. D started a new job in Boston last week and signed up for a new PCP two days ago. When she came down with flu-like symptoms night before last, I told her to call her PCP and make an appointment since D has asthma and a previous history of pneumonia following a bout with the flu. D called, but the PCP’s receptionist told D there is no way the PCP can treat D for this illness because she has never had a well visit with the PCP. I then told D she should go to the ER because I thought the doctors would prescribe Tamiflu since D has asthma and a previous history of pneumonia with flu.</p>
<p>Well, the ER doctors told D she has a probable case of H1N1, but they sent her home without a prescription for Tamiflu. So who exactly is being prescribed Tamiflu? </p>
<p>D is very ill today with a high fever. I told her to take a cab to the CVS Minute Clinic to see if they’ll prescribe Tamiflu. D is almost past the 48-hour window for Tamiflu to be effective. I’m pretty upset about the whole thing.</p>
<p>Yes, Tamiflu really is important to be taken in the window & hope she’s able to get it from wherever she can! Sorry your D is getting the run around, especially when she’s so sick & feverish! I’d be very upset also if I were you.</p>
<p>It was really tough getting Tamiflu around our state & many other places when H1N1 first was hitting the headlines. I believe supplies are more readily available these days.</p>
<p>mapesy–</p>
<p>The prescription does not have to come from a Boston doctor; if you can find a pharmacy near your daughter that has Tamiflu or Relenza in stock, then any doctor who has seen her and knows her medical history and current status can call it in. If you call pharmacies near her and find out if they have Tamiflu in stock, maybe you can have a previous physician of hers call it in as soon as they have spoken with her.</p>
<p>I understand that the CDC is recommending against indiscriminate use of Tamiflu to protect against the development of Tamiflu-resistant strains, but aren’t people with asthma and other serious underlying conditions the exact people for whom this drug is intended? </p>
<p>Perhaps your D could describe her symptoms to the specialist who has treated her asthma etc. in the past and obtain the medication that way, once you know a local pharmacy that can provide it to her.</p>
<p>Good luck!</p>
<p>Thanks for the suggestion, Nester. I called D’s old PCP here, but they won’t prescribe anything because it’s been two years since they’ve seen her and D’s medical records are in storage. I then called the clinic at D’s old university that’s treated her more recently, but the only thing it can do is send her medical records to her new PCP (who won’t treat her for this illness.)</p>
<p>D went to CVS, but they wouldn’t prescribe Tamiflu.</p>
<p>We’re out of options at this point. So here I have a D with asthma and a history of pneumonia with flu and no one will prescribe Tamiflu for her. She’s scared and so am I. :(</p>
<p>I think this might be the moment to call the medical director of the new PCP so the two of you can work out a way to save the clinic from committing malpractice in their refusal to treat an acutely ill patient who is endangered as a result of underlying condtions. Worth a try. </p>
<p>I cannot even imagine what you must be going through. I’m wondering if the Boston area has “doc in the box” kinds of clinics that treat walk-ins and that do not have a policy of denying Tamiflu to appropriate patients. The internet and a few phone calls could conceivably yield such a place. Also, as difficult as it would be to get into a private practice doctor at a moment’s notice, do you have friends in Boston who have a doctor? </p>
<p>I also think that it might be worth phoning ER’s at a different Boston hospital, talking to the nurse there and explaining the situation, and perhaps sending your daughter there if they have a policy of prescribing for H1N1patients in the target age group who also have underlying conditions.</p>
<p>Agree with Nester about calling different ERs in Boston area to find one who will prescribe Tamiflu **& has it in stock **for your D’s situation. Time is critical here and the battle with the medical director of the new doc may take too long.</p>
<p>Good luck! Be sure that wherever D is sent both WILL PRESCRIBE & HAS TAMIFLU IN STOCK!!</p>
<p>Thanks so much, HImom and Nester. You’ve both been very helpful. I called Mass Gen and it’s testing for swine flu. If D tests positive, they’ll prescribe Tamiflu. D is too sick to go by herself, so she plans to go when her friend gets off work. Her window for Tamiflu is closing fast…</p>
<p>I feel badly that I encouraged D not to go to Mass Gen last night, but to go to the walk-in clinic at Mt. Auburn instead. I’ll know better next time.</p>
<p>S in Boston also has a probable case of H1N1, but he doesn’t have any underlying health conditions so I’m not as worried about him.</p>
<p>even if Tamiflu is started in the first 48 hours, it is not a miracle cure. It decreases the number of days of flu from 7 to about 51/2 - that’s it. It is usually mentioned in news reprts so people won’t freak out once they think there is a sure-fire cure for a case of influenza.</p>
<p>Very, very happy to hear this mapesy! </p>
<p>My next suggestion is that if your daughter will go for this, pay for a taxi to get her to Mass General right now. As you say, the window is closing, and who knows how long she’ll have to wait once she reaches the hospital. </p>
<p>Be sure that she knows that she must tell the triage nurse and the doctors about the seriousness of her asthma, her pneumonia history, and other conditions up front!</p>
<p>Gee, I have been an ER nurse for many years and pts will generally tell you what they would like and we try to be accommodating. I would suggest your daughter insist on getting a prescription for Tamiflu, in light of her previous hx I think it is appalling that the first ER did not prescribe it for her.
Good luck.</p>
<p>I know that Tamiflu isn’t for ALL flus but it made a world of difference for me the times I took it for different viral “bugs.” I agree that she needs to let the triage ER nurse know everything and have someone who is very persuasive go with her to the ER to be sure she’s started immediately on Tamiflu; it doesn’t do much/any good if it’s started too late.</p>