One Patient's Story
By Laura Lee Bloor
Reviewed by Melissa Conrad Stöppler, MD
When Orange County, Calif., native Jennifer Johnson* started feeling feverish with a sore throat, headache, and body aches, one of her restaurant coworkers teased that she probably had swine flu.
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Unfortunately, the joke turned out to be real.
It was a Saturday night, and 24-year-old Johnson was working as a server at a London restaurant. Her throat had been sore and scratchy all day, but she wasn't too concerned. Around 10 p.m., she felt a sudden strong fever develop in addition to some mild dizziness, loss of appetite, and painful body aches.
After being released from work, she stopped by the corner market on her way home to pick up a thermometer to take her temperature. The store was sold out of them.
The H1N1 swine flu has hit the United Kingdom hard (more than 100,000 cases and 30 reported deaths, according to the U.K.'s National Health Service [NHS], as of press time on July 30, 2009). In a panicked response, people have taken to stockpiling thermometers, ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever), and other over-the-counter cold and flu medicines, Johnson explains.
After leaving the store, she came home and went to bed but had trouble sleeping because of anxiety.
"You can't help but get nervous," Johnson said. "That first night I was afraid to go to sleep because I was so stressed that I might have swine flu."
She stayed in bed Sunday, continued to manage her fever with ibuprofen, and drank lots of fluids. As soon as the ibuprofen would wear off, her fever would spike again.
"I don't catch the flu very often, but the only thing that caught me off guard (with the swine flu) was the fever, which lasted three days, whereas before, my fevers had always gone away within a day," Johnson said.
By Monday, her symptoms hadn't improved and her fever wasn't going away, so she called her local general practitioner. She hadn't ever been sick enough for a doctor's visit while in London, so she had to fill out new-patient paperwork.
The doctor's office didn't want her in the office if she had flu-like symptoms that could be H1N1 swine flu, so Johnson's flatmate (roommate, for those of us in the United States) walked to the doctor's office and brought it back for her. Her flatmate then returned the paperwork to the doctor's office. Once Johnson was entered into the system, she was put on a waiting list to be called by the doctor.
About two hours later, a general practitioner called Johnson and reviewed her symptoms and medical history. The doctor declared that she more than likely did have H1N1 swine flu.
Because Johnson also has asthma, it makes her a "high risk" candidate for H1N1 swine flu and for developing further complications such as pneumonia. Her vulnerability led the general practitioner to prescribe her the antiviral medication oseltamivir (Tamiflu). Had Johnson not had the underlying condition, she probably would not have been given the Tamiflu treatment, she said, as the doctors are concerned about having a sufficient supply of the drug should mass administration be needed.
As of press time, England is the only country using the National Pandemic Flu Service that allows patients to have their symptoms and medical history reviewed by a general practitioner over the phone or Internet. If the doctor determines the patient has H1N1 swine flu, he or she may provide the patient with a prescription code to take to the pharmacy for treatment.
Johnson's flatmate couldn't pick up her prescription until after work, so it was Monday evening before she was able to take her first dose of Tamiflu. She received a five-day prescription: two pills, twice a day. It took 40 minutes to get the prescription filled because the pharmacy was so busy.
Monday night, Johnson developed a cough, her sore throat worsened, and her fever would come and go. She awoke around 3 a.m., having difficulty breathing. She called home to her mom for advice, and her mom suggested she drink chamomile tea with honey and lemon. Johnson found this home remedy controlled her cough and sore throat better than the cough syrup she had been taking.
Between Tuesday and Wednesday, Johnson noticed her fever was lessening, but her cough and sore throat seemed to be getting worse. She called the general practitioner's office again, and the doctor said not to worry unless she started having new symptoms or extreme difficulty breathing.
By Friday, she was feeling much better with just a little sore throat and cough. Johnson no longer needed the ibuprofen. She continued to stay home and was out of work through Saturday when she completed her prescription.
By the following week, she was back to normal. Upon returning to work, she learned that many of her coworkers had relatives who had contracted H1N1 swine flu, and two of her female coworkers had developed it after she did. She's not overly worried though.
"There's this perception of, Oh, you're going to die if you catch swine flu, and it seems like after my ordeal, it's not as big of a deal…The hysterics surrounding swine flu seem a little bit too much," Johnson said. "It's basically catching the flu."
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* The patient's name has been changed to protect her privacy.