Category Archives: Medicine

Notes from a previous pandemic

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From emails sent while down with the H1N1 flu, 2009…..

Flu hit suddenly Sat noonish. You will crack up…Fyl had made some hummingbird nectar and put it in a dry goods container that was easy to topple.  I envisioned sticky red hummingbird nectar everywhere and freaked out, poured it into the sink and raged a bit about sticky stuff, then retreated to the couch and had an inexplicable panic attack for about a half hour, obsessing over sticky stuff. [I am epileptic and this was apparently some weird epileptic panic attack set off by the virus.] Then I got incredibly sleepy and managed to make it into the bedroom, shut the blinds, strip to skivvies and slip into bed under the covers and slept for a couple hours. Woke up damp with sweat. Up maybe 15 minutes and back to bed. Woke up sweaty again, with a real flu-sy feeling. No respiratory stuff, some GI discomfort.  Just feverish and sleepy. Sometimes intensely sleepy. Chills and mild fevers come and go. I looked up flu symptoms and this matched the mild symptoms of the swine flu that are being reported, especially the “lethargy, sometimes extreme”. Just a hint of respiratory stuff, a sore throat for a hour or two, mildly stuffy nasal thing. Cramps and aches pretty minor, chills come and go, but wish I could shake the tiredness. Seems to lessen by the day.

On Friday we were at a jazz joint and ran into a friend who had just returned from NYC [where H1N1 was pandemic] and was telling me all about the packed nightclubs. He leaned right into my face a couple times to be heard. This thing started about 7 or 8 hours later. The force it hit with is obvious by how it so threw off my epilepsy meds and caused me to freak about sticky stuff. I suppose I would have freaked out about anything. Sticky stuff is just funny…..

Having trouble reading, btw.  Get groggy. A drag.

My only real complaints about this thing are that the drowsiness makes it hard to read and that it’s severely circumscribed my quality partying time. We must have our priorities.

I appear to be on the recovery side of a sudden flu that hit me Sat afternoon the symptoms of which match the current swine flu. Never had a flu quite like it. Mild but the lethargy was debilitating…you just stopped everything and fell asleep. Chills, bone aches, a little GI discomfort, like that…respiratory symtoms almost totally absent…looked like I was gonna develop some Sat nite but dissipated in an hour or two, and had a cough and sore throat the same way. But muscle cramping, aches, mild fever and extreme lethargy…. Damn thing hit so fast om Saturday that within an hour I was in bed, asleep and sweating. Very dramatic onset. You can see how were one to have more severe symptoms it could be life threatening really fast. The first sign that something was amiss was a panic attack for the stupidest reason that left me shaking and freaked out—apparently the immune system reaction was so strong it must have completely thrown off my epilepsy med levels…within thirty minutes of that I was in bed just about unable to move. It was very impressive.

I woke up after a couple hours and tried to use the head—GI was upset—but passed out of the toilet!!! Right back to bed. Woke up soaked later and recognized that flu-sy feeling all over. That’s when I started to look up symptoms and found out I was kinda textbook H1N1. Now….Friday night—less than 24 hours earlier—we ran into an old pal who had just gotten back from NYC where he spent times in the jammed nightclubs…and who to make himself heard over the band in the room was coming in close to my face….I kinda figure that was contact for me.

Anyway, I am so proud to be the first person I know of with swine flu [as it was being called in the media at the time.] Alas, I quarantined myself, and Fyl as well so we have not done a very good job of passing it on. Even kept separate from her as much as possible. Hopefully back at work on Thursday.

Been home on the couch with the swine flu a few days. There was just a knock at the door. Jehovah Witnesses. I shouted from inside Black Plague-like that “we have the flu in here”. Jehovah filled them up with fear, I guess, as they blessed me through the door and fled down the steps.

I’ve been fascinated with the pathology of influenza ever since my dad used to tell me the stories he’s heard from his mother about the 1919 Spanish Influenza.  I read whatever I could find on it, which hasn’t been much till the last dozen years or so..and what I could never fathom was how a flu could be so virulent…not so much how contagious it could be, that I could understand, but the rapidity of the onset. How someone could be feeling fine and within an hour desperately ill. It didn’t seem conceivable until last Saturday.  I went from perfectly fine, feeling great, to passed out in bed in less than thirty minutes. The first effect was a bizarre panic attack of a few minutes about nothing, without warning, absolutely out of nowhere, followed within a couple by trembling, then a sort of lower extremity numbness, followed by chills and then a sudden attack of fatigue so extreme that all I could do was go into the bedroom, close the blinds, undress, get under the covers and fall asleep. We are talking at most fifteen minutes here. I probably laid in bed at the most five minutes utterly exhausted before passing out utterly. Fyl got into the shower after my initial freak out (being married to an epileptic weirdo she paid little heed to that) and by the time she got out of the shower I was dead asleep. She woke me up I think two hours later. I vaguely remember being sweaty and having vivid dreams. I got up. dressed, and I think told her we could still do the things we had planned on that night. I felt like I had the runs or something coming on, some kind of GI discomfort.. I passed out in the john, got up and immediately went back into bed. I guess i slept another hour and woke up sweaty again, got up, and realized that I felt like I had the flu. That flu feeling all over. Thus I had been sick for a good three hours but been so stricken with fatigue I didn’t even know it. That’s when I wondered if I might have that new flu, as this one was unlike any flu I had ever had. I knew the symptoms were mild, and there was so lung infection and just became completely fascinated. I was actually exited to be experiencing this new flu. At last I understood just how influenza could kill healthy people…. You see, the onset is so rapid, and so overwhelming, that if the symptoms did include respiratory problems, they would develop with incredible speed, so fast that even the healthiest body would be challenged to deal with them. The overwhelming immune response can kill the patient. All my responses—the crazy nervous system response—the panic attack—and the trembling and the fatigue were all side effects of my massive immunological response. That is how all those perfectly healthy young people died in 1919. That I knew. But this was how it felt. This was what it was like to have your body impacted by an extremely virulent form of influenza—even though the degree of infection was far smaller. And weird as it sounds I was really thrilled to get this. Now I knew.

By the way, the only thing I can compare it too in speed of onset is food poisoning. It hits with the same velocity and power.

My god I sound like Mr. Spock.

[I was the first person I knew to come down with the H1N1 flu and certainly the only one to admit it. I wasn’t allowed back to work for ten days. I knew dozens of people who felt achey and slept for several days, but none were dumb enough to call it the flu.]

They did not have a flu shot in 1918

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The 1918 influenza epidemic infected half a billion people out of global population of 1.8 billion. Somewhere from fifty to one hundred million of those people died. Nearly everyone killed by the flu was under 65, with most being between 20 and 40, in whom the body’s immune system’s reaction was so severe that lung tissue was reduced to a thick mass and the victims drowned in their own phlegm. A perfectly healthy young person could fall sick in the morning and be dead that night, as a strong  immune system made the disease all the more deadly.

There was no flu shot in 1918, which means people in 1918 were just as vulnerable as people who didn’t get the shot this year. Fortunately the flu this year is vastly less deadly, and will probably only kill a few tens of thousands world wide. It’s a roll of the dice every year, but at some point  a flu virus will evolve that drops people like flies. Could be next year, could be in a hundred years. If you get the shot you lessen the odds of dying a rather quick and ghastly death. It’s up to you.

Narcan

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The great thing about naloxone (aka Narcan) is that it saves lives. It really is a miracle drug. You can overdose on heroin and the paramedic can administer it quickly and you are good as new. Which is what is so great about naloxone, if the shit you just scored is too strong and you OD then the paramedics can bring you back to life. And if the shit is too strong but you don’t OD, then it’s just a better high. So why not go for the bigger hit? Come on, live a little, especially as you won’t die a little. You probably won’t die at all. Naloxone just makes being a junkie more fun and far less dangerous. Overdose deaths have plummeted, even as overdoses skyrocket. That is no accident. There are more overdoses now because the odds of dying of an overdose have fallen by several orders of magnitude. I can’t see overdoses dropping anytime soon, either, not with all that naloxone around. Just the opposite, the number will keep rising. Why? Because medical science has removed natural selection from the process. There are no more Darwin Awards for junkies. Everyone lives, everyone gets high, and only the very unlucky die. Like maybe the ambulance gets a flat tire. Shit happens. But how often does an ambulance get a flat tire? We have made heroin addiction a much more viable lifestyle, though a more expensive lifestyle, wanting higher and higher highs. Much higher than ever before. Those pictures of parents OD’d in front of their children? Parents used to worry about ODing in front of their children. Not anymore. A few drops of naloxone (aka Narcan) in the nose and mommy and daddy are good as new, though in jail, and the kids have been taken away. Oops. But still, naloxone means anyone can be a junkie now. Who can? We can! Narcan. Ask your druggist.

narcan

Contagious cancer

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In shellfish, the Live Science headline says, cancer can be contagious. “Recently scientists discovered that cancer cells can sometimes escape an organism and spread to others. These cells are clones that are nearly identical to the originals, save for mutations that might have popped up since they diverged from the initial cancer cells.”

Genetic analysis of the cancers and their hosts revealed that in nearly all of these cases, the genetic makeup of these cancer cells did not match those of their hosts. Instead, the cells came from other animals. Then comes the kicker. The finding suggests that transmissible cancers might be far more widespread than previously thought.

I knew that there was a contagious facial cancer afflicting Tasmanian devils (and in fact, decimating the population.) They nip each other in the face like you and I shake hands, but while we once spread warts (mom told us) they pass on a horrific cancer. And I didn’t know they’d found contagious cancers in dogs, spread by puppy love. But these involve intra-species transmission, though, one he dog to a she dog, or one snarling Tasmanian devil to another. The thing about this news story, though, is that they’ve found a cancer had spread from a clam to a mussel, that is, inter-species transmission. And while there’s no way you or I will ever catch this cancer–we are way too different from clams and mussels, even the dumbest of us–it does mean that we might be able, some day, to catch a cancer from another primate species, at least. Or maybe even from Fido, wagging his tail every time you look his way? But as no cancer has jumped from human to dog or vice versa in the 20-30K years that dogs (née wolves) and people have been hanging together (I assume we could have detected any such transmission genetically) it seems unlikely. Specific cancers are too tied into specific genetics to be able to just flit from one mammal species to a distantly related other, and people and dogs and all their carnivore and primate predecessors and their pre-carnivore and pre-primate predecessors have each been on their merry but separate evolutionary way for maybe 80 millions years, as dinosaurs still stomped about. And though both are mollusks, the last common ancestor of mussels and clams existed over 480 million years ago. Yet half a billion years later a clam can “catch” cancer from a mussel. A half billion years is an incredibly long time, both in terms of deep time and genetics.

We might catch the same sort of cancer from the same carcinogen as a dog, but it’s highly unlikely a dog’s cancer cell could settle amid our healthy people cells and metastasize. But here a cancer in mollusks that has done just that. No one knows how, though there is one revolting hypothesis that it comes in excrement that floats on in with sea water, a mussel leukemia transmitted in the way we transmit cholera, though all we ever did was drink and bathe in the water, while mussels eat and breathe it. The sea is their air. Imagine breathing in cholera laden air, as if all the old ideas of bad air causing epidemics (“malaria” comes from the Italian for bad air, mal aria) were true. Perhaps that is how this cancer (a mussel leukemia) spreads. Not that the mussels are thinking about it. But I am, and the entire idea is creepy. You have to wonder how often this happens. In a small population a contagious cancer could theoretically push a species to the point of no return. Perhaps even a hominid species. What have the evolutionary implications been over the past half billion years as cancers crossed from one species to another closely related species? Has genetic variation been driven, in some small sense, by mutations that allowed an individual to fend off the wandering cancer cells from a closely related species that had devastated his otherwise identical siblings?

Thinking about cancer is bad enough. But thinking about contagious cancer gives me the willies. Change the subject, please.

Fleas

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[c. 1998]

The good news is that ground squirrel fleas are pretty species specific and you get bit by standing close to a vast ground squirrel colony and snapping pictures of the little devils to try out the autofocus of your new camera. The bad news is that if you are stupid enough to do so, you’ll itch to learn everything there is to know about ground squirrel fleas. Or any kind of fleas.

Your dog fleas are probably cat fleas. Human fleas are no longer that popular anymore, and with youngsters waxing pubic hair off with abandon, their little nature preserves are on the endangered list, at least in Los Angeles. Los Angeles has always been hip to fleas. As has all of California. The Spanish certainly were. Pulgas–fleas–pops up all over the map in this state. There was a whole Rancho de los Pulgas up in the Bay Area, one of the original Spanish land grants. Rich people live there now, making big money from little circuits no bigger than a flea. Not far away, ground squirrels host fleas that still carry the bubonic plague.

As scary as that name sounds, it is not the same plague that swept through Europe in the 1300s. That was a rat driven plague, the plague spreading to the human population because rats infected by the bacteria (Yersinia pestis) died and forced the rodent fleas to bite people, something they no doubt found distasteful but in a famine any host will do.

I don’t know who the fleas bit after all their human hosts died. Maybe no one, and they starved to death in little flea droves, hence ending the plague. It’s interesting that some parts of Europe were untouched by plague. Poland was spared almost entirely. But in other places–especially along the northern Mediterranean coast–the land was swept clean of humanity. You never know about fleas.

Think of it… Fleas had been feeding off rats happily for ages when somehow they became infected with the Yersinia pestis bacteria which, transferred from the flea’s stomach to the bloodstream of the rat, promptly killed the rat. Then the fleas, starving, leapt onto the next most common mammal, people, and killed them off. That left the fleas hostless and at the mercy of the frigid European winters. Death came quickly. And when fleas died, Yersinia pestis died with it.  The Black Plague was a disaster for everyone involved. People, rats, fleas and bacteria, everybody. Not a good business model.

Without doing any research at all, and in the true spirit of the Internet, I wonder what triggered this whole catastrophe. Maybe Yersinia pestis had been in rat guts for ages, but there’d been a genetic mutation–bacteria mutate at an astonishing rate–that suddenly rendered one gnarly. The flea it occupied then killed its rat host. Oops. The flea jumped ship. Another rat died. Meanwhile said flea was reproducing with the usual abandon, each baby flea carrying the mutated Yersinia pestis, and each killing its rat host. Every time a rat died the flea had to find another rat, and on and on. Soon rats are dying all over the place. Then people. I should mention that In people the plague could turn pneumonic, that is spread simply by coughing, no flea bite required at all, like a bubonic flu*. Then the thing really took off. All because some gene mutated just once in a Yersinia pestis . Again, I profess no expertise in this whatsoever. But this is the internet.

Or it could have been a parasite. I don’t mean the flea as a parasite, but something parasitizing the flea, a parasite within a parasite. Parasites make their hosts do strange things. Even a parasite with a bacterium for a host. Or maybe it was a virus that caused a change in the DNA of Yersinia pestis which rendered it fatal to rats and people. Again, this is baseless extrapolation, but this is the internet, and the weirdness of nature is fun to think about. But enough of this.

I think about fleas and I think about plague and am filled with terror. Then I remember that one of the Rothschilds, with all her money, was the greatest flea-ologist ever. Ever. She wasn’t even an entomologist (or more specifically, a siphonapterist), she just had a thing about fleas. Imagine her vast but tiny little collection. Imagine a Rothschild, with all her money, bounding after a flea bounding. The rich are different from you and I.

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* I’m leaving out the rarer septicemic variant, as it is simply too ghastly to think about.