Tuesday, May 26, 2009

Case Study: H1N1 Swine Flu, my influenza experience

Is this really a case study? Okay, it's more of a personal accounting of the twelve days in May of 2009 during which I was suffering from severe respiratory influenza related to the H1N1 Swine Flu.  I documented the course of this illness because it was so weird and prolonged.  I decided to post my experience for the benefit of others going through a bout of H1N1 influenza.

Here's a rundown of my recent illness:

Day 1: Thurs. eve., May 14th. I noticed that tell-tale "tickle" in my chest and the urge to cough deeply. My husband the mailman had brought this upper-respiratory virus home earlier in the week. After four days of body aches, rest, and frequent cough, he was finally feeling well. I had planned to go visit my elderly parents for the weekend. With the symptoms beginning, I decided to re-evaluate on Friday morning. I didn't want to take them any germs.

Day 2: Fri. May 15th. Woke up feeling "icky" and immediately postponed visiting my folks. A bad headache, cough, body aches and really sore throat came on gradually through the day until I was officially sick by late afternoon.

Day 3: Sat, May 16th. Full blown sickness all day. My sore throat was severe. The headache escalated with every cough and my over-the-counter meds didn't make a lot of progress against any of the symptoms. Lemonade, Popsicles, and fitful sleep punctuated by strange dreams were the theme of the day. I emailed my supervisor to let her know I needed a substitute for my nursing shift on Tuesday.  The way I felt, it was obvious I wouldn't be well enough to be around either patients or other staff by then. I assured her I'd be able to work my planned Friday shift, however.

Day 4: Sun, May 17th. The second day of "full blown sickness."  I was not feeling at all better this day.  I had no appetite at all, a very "icky" taste in my mouth, terrible sore throat, and a frequent cough with nasty green phlegm. My husband was again a huge help in bringing me fluids . . . I experienced constant muscle aches in the upper arms, thighs, abdomen, lower back, and what felt like spasms of deep bone pain to my left lower leg and right upper thigh. (I didn't have much headache from this day forth, however). By late evening I got out of bed and onto the couch to rest so hubby could sleep without being disturbed by my constant coughing, etc..

Late at night I felt well enough to putter around the kitchen briefly. But I suspected I was feverish and confirmed that with the thermometer. (Fever is nature's way of killing bad germs, so that doesn't frighten me at all by the way. I was hoping this meant the illness was going to peak and resolve). I began to experience chills and was generally just plain sick. I did take a dose of Tylenol (acetaminophen). My fever stayed in the 101-102.5 degree Farenheit range most of the night.

Day 5: Mon., May 18th. My highest temp was 103 degrees Farenheit at 6 am on Monday morning, but fever and chills stayed with me for several days. My cough was bringing up very thick, green phlegm. My plan this day was to call the hospital where I work to speak with the employee health nurse. I wanted her to know about my fever and influenza symptoms.  I also asked if our facility was doing any lab surveillance for flu among the employees. (We were not).

I also phoned my doctor's office to ask if they were interested in a sputum specimen for surveillance. (Again the answer was "no").  The nurse related my symptoms to the doctor, and advised that the doctor wanted to see me in the office based on my symptoms, but lab surveillance for H1N1 was only taking place in hospitalized patients in our community. There were no appointments available with my doctor on this day, and I honestly didn't feel well enough to get out of bed anyway so didn't even consider going to see her. I had my laptop at the bedside and felt well enough to write a blog note about my flu. I felt like a "wuss," because my health is robust, and I'm not used to being so fatigued and achy.

My only moments out of bed on this day were to visit the nearby bathroom. I caught a glimpse of my reflection and noticed my face was a waxy, pale yellow. I thought I looked jaundiced. My tongue was also, alarmingly, VERY PALE. I thought the fever had somehow left me anemic. For a moment I thought about checking the whites of my eyes in the mirror, but the room was too dark and the malaise made the hand mirror seem "too heavy." This was a day of feeling completely ill once again.

Day 6, Tues., May 19th. More of the same. I was again shocked to see how yellow my skin was as I passed the mirror. Once again, I thought about looking at my eyes with the hand mirror to check for icterus--but I simply lacked the energy. There was no noticeable improvement in body aches, sore throat, cough or fatigue. I stayed in bed, and was just up to soak in the tub briefly and use the bathroom. I had my laptop at bedside, but didn't have much interest in anything. Although I was technically "resting," it was difficult to get any satisfying sleep.

In the early evening, one of our cats was acting strange and hurt. It seemed like he'd been stung by a bee. We had no liquid benadryl for him in the house so I reluctantly dressed and went to the local Walgreens drugstore. I planned to grab a paper mask to wear in there, but they didn't have any. Not wanting to infect anyone, I made my purchase very quickly and immediately went home. Of course by then the cat seemed recovered enough not to need the medicine. I returned to bed immediately still feeling quite ill and coughing frequently with the constant sore throat and no appetite.

Day 7, Wed., May 20th. I had a feeling that I would not be able to work on Friday after all. I wasn't well yet--still coughing green stuff constantly. Still with a terrible sore throat. After no fever for two days, I started with chills again in the evening and a low grade temp of 100.5. I thought I'd better see the doctor the next day, just to get a note for work so they wouldn't think I was "playing possum."

Day 8, Thurs., May 21st. I was the patient in a mask at the doctor's office.  (Well, I did see one other patient in a mask). The doctor was surprised how sick I was.  She immediately acknowledged influenza and she also suspected possible pneumonia as a consequence.

New symptoms had also developed over the past 24 hours--my left eye was draining green pus. My temp was still hovering in the low 100's. My neck glands were swollen and tender. At the doctor's office I had a chest xray, throat culture and blood work. I told the doctor I felt 70% of normal--so much improved from earlier in the week. Still, the sore throat, cough, and malaise were lingering . . . I was prescribed antibiotic drops to instill in the infected eye.

I immediately returned home to rest. My husband kindly went to get the prescribed eye drops at the pharmacy, and while there he bought me a teddy bear. That's how pathetic I was--sick enough that my husband felt a teddy bear was in order . . .

Reluctantly, I had to notify my hospital yet again that due to this lingering illness I would have to cancel my next scheduled shift (on Sunday).

Day 9, Fri., May 22nd. My doctor called in the morning to give me some results. The chest xray hadn't been read yet by the radiologist, but the lab proved there was no bacterial infection in my throat. The unusual finding was in my blood work. My liver enzymes were alarmingly elevated suggesting that the influenza virus had battled with my liver and caused an acute hepatitis earlier in the week. My shocking yellow color on Monday and Tuesday was, indeed, jaundice.

I was actually feeling better this day . . . so much so that I decided to sanitize certain parts of the house. I focused on disinfecting my kitchen/dining area which included a thorough mopping of the floor and scrubbing of the sink, refrigerator, counters, and trash can. I vacuumed my living room including the crevices of the couch & chairs, did loads of laundry, changed all the sheets, and threw open the doors and windows to get fresh air in and germs out. I even cooked my son a light supper, but was totally spent from the activity before my husband made it home from work.

Overdoing it during that burst of energy really exhausted me. I took a 5-hour-nap on the couch before going to bed for a night's sleep.

Day 10, Sat., May 23rd. Because I had felt improved on Friday, I was optimistic that I'd be able to have a normal day. Instead I was once again very fatigued and my abdomen was very sore in the round ligaments from the constant deep productive cough. I mostly rested to make up from overdoing the house cleaning on Friday.

Day 11, Sun., May 24th. This was a day of actually feeling better for a change. As it was Memorial Day weekend, I wanted to take advantage of a sale at the nearby Bergners store. I drove over, purchased my items, and came home. The air was so fresh, I spent time in our yard, checking my flowers and vegetable plants. The herbs smelled so good, it was inspiring. I got out some branch cutters and did some pruning.

Once again, I later found that that trying to resume my usual level of activity was taxing enough to exhaust me into a long nap. When I woke up hours later, I was suffering from positional vertigo. I've had this vertigo (in which it feels as if the room is spinning when I turn my head) occasionally in the past, but it's always rather disconcerting.

Day 12, Mon., May 25th. The sore throat was almost gone. My eye was better. I still had positional vertigo. The cough was what I call "moist"; it was nagging in spasms that interfered with sleep, but not bringing up as much phlegm. My need for napping was ridiculously high, catching up on a sleep deficit from the illness, I am sure. I still had occasional body aches and pains related to the flu (including the deep "bone pain" in my right thigh that actually persisted on and off for months after this illness!) My appetite was not back and the "sickish-taste" was still there. But, I felt like I was 93% back to normal. Fortunately, I had no scheduled days of work this week.

Day 13, Tues., May 26th. My most lingering symptom was still the cough and a vague, generalized pain in my chest, a constant presence over the past week or so that was annoying but not unbearable. I still had positional vertigo, but my energy and enthusiasm started to return and I was feeling interested enough to write for a while. I planned to call my doctor to see what the xray result showed. I was keenly aware by this point as to what an unusually peristent illness this had become. Because the symptoms had waxed and waned so much, I wasn't even confident at this point that I was truly over it yet. (I am certain that I've never been affected by an illness for so long in my adult life).

Follow up: My chest xray was negative for pneumonia. A week after the first blood tests, my liver enzymes had returned to normal. I was still coughing "mildly" and bringing up (by then) clear phlegm into the first week of June when my son graduated from high school. By the second week of June, I was completely well, except:  my job requires a great deal of physical exertion and I must say that when I returned to work, I noted a distinct loss of stamina after my illness with the H1N1 Swine Flu.

My H1N1 Phlegm:  I took this phlegm photo at the end of my May 2009 bout with H1N1 Swine Flu.  I was feeling quite a bit better at the time, but still effortlessly coughing wads of disgusting phlegm.  I know it's gross . . . my lungs were full of this stuff, and it was much worse earlier in the illness before I had enough energy to document it.

Search terms that bring traffic to this blog post.  As of March 2010 my search log continues to show me that this is my most-read blog entry.  People most frequently use search terms that include "lingering cough," "yellow (or) green phlegm," "H1N1 with vertigo," and "H1N1 with jaundice (or) elevated liver enzymes."  (Importantly, I periodically also see search terms that suggest individuals have developed jaundice after receiving the vaccine against H1N1).

You might find these relevant articles of interest:

This page from the CDC website explains when it is recommended to collect specimens for H1N1 surveillance. Obviously we want to have an idea of how much influenza is out there, where it is located, and the emerging patterns of the illness. At the same time, it's unwise to test everyone, everywhere for the illness. We'd be expending resources at a cost that doesn't give us any benefit. Influenza as a general diagnosis can be made based on symptoms. Antibiotics are not a treatment for viral illnesses like influenza, and anti-viral medications are not frequently used either. This is one of those illnesses that requires our immune system to fight the virus.

Here is a 2006 article explaining a relationship between Influenza and a bout of acute hepatitis: Systemic Viral Infections and Collateral Damage in the Liver by David H. Adams and Stefan G. Hubscher. (American Journal of Pathology. 2006;168:1057-1059.) See paragraph 2, Understanding Hepatitis in Influenza.

Want to review the basics about influenza?  Here's a link to my general information about the flu.
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JAS said...

I appreciated hearing about your experience. I was recently diagnosed (after having symtpoms for more than a week). Given this illness being so new, it is hard to find info about the course of the illness. I too feel this has been the longest flu I have ever had... it's more than 2 weeks and I am still not 100%.

JAS said...

Thanks for your personal experience. I too have h1n1 and am finding it hard to get info on the course of the illness. I have been suffering from it for 2 weeks now and I am still not100%.

Anonymous said...

Your description is very truthful and exactly as I have also experienced. The fever and long term complication potentials are what make this flu more dangerous than a standard one. Comes on quick and hits hard and lingers for days.....not sure if anyone around me will get it and there were a allot of people around me....we shall wait and see.

Diddi said...

Thanks so much for posting this. I am 19 weeks pregnant and have always been very skeptical about this *media flu*, until I got somethign nasty 3 days ago. Today my husband had to come home early just to watch over me and take care of the kids, which is when he stated I looked "really yellow", threw me off guard enough that I am considering going to my personal physician just to check my liver function(especially being pregnant. Hopefully nothing comes back wrong, but I never thought that maybe my husband wasn't just imagining my color.

Carolyn Cooper, MPH, RN said...

Wow, Diddi--Thanks for your comment. I sincerely urge you to see your physician to follow up on your gut instinct. You know what? My statistic counter allows me to look at the terms that search engines use to guide viewers to this blog entry. It amazes me how often "H1N1 with jaundice" and "H1N1 liver enzymes" appear among the search terms, so you and I are far from alone in experiencing this phenomenon.

Anonymous said...

I have never commented on a blog before but want to thank you for your post. My 8 yr old had swine flu last week with his fever starting Tues 11/10. he had felt tired/achy/headache/sore throat for a few days before that. His fever resolved on Friday 11/13, and he has felt much better, but seems to have "spells" of fatigue each day, while otherwise seeming fine except for occasional lingering muscle aches and headache. I keep thinking he is "better" and them the school calls and tells me he is feeling poorly. 2 hours later he is fine again for the rest of the day! he is being tested for mono/infections etc (did the blood work yesterday) but I am thinking he is just still recovering from this flu! Your post was reassuring to read. Thanks.

R. Elmi said...

Hi, Doctor Cooper. I caught a nasty flu 2 weeks back that I later gave to my mom. We both got terrible sore throats and bad coughs along with nausea and for her, a fever. Because of my mother's asthma she was hospitalized and then diagnosed with H1N1. I haven't been diagnosed with H1N1, but since my symptoms were almost identical to my mother's I assumed I also had H1N1. I've recovered mostly by now, but I have this lingering cough.

I've seen a mention of a lingering cough on several sites which makes me think it's a normal symptom of H1N1, but mentions of the cough read like it's barely a problem. My cough is disrupting my life. I can't sleep at night and I'm getting splitting headaches from the intense coughing fits. I'm still coughing up phlegm, but it's clear now, which makes me think the flu is really over.

None of the over the counter cough syrups have worked me for me and I currently do not have a primary care doctor. I've called the H1N1 hotline in my state and I've contacted a local hospital for more information, but I haven't really heard anything specific. You mentioned a lingering cough in your account and I wonder if you might be able give me a more detailed description of how long it lasted and what you did to mitigate the discomfort?

I'm sorry for the long comment and the demands, but I'm a little desperate. Thank you for writing up your description of your experience with H1N1. I've found your account and others like yours extremely helpful.

Carolyn Cooper, MPH, RN said...

Hi, R. Elmi, Thanks for your comment and I absolutely understand where you are coming from. Quickly, before I respond I'll just mention that I'm not a medical doctor and don't have a PhD. I am a Registered Nurse with 15 years experience and a master's degree in public health.

Regarding your experience, I appreciate you sharing it, because it does help others who also read this article. Honestly, I get blog hits from all over the world for this article and "lingering cough with H1N1" is one of the main search terms used so you are in good company right now.

My spouse and I also suffered that same prolonged cough. It was exactly as you describe. Very miserable. Our experience was similar in that the "usual" cough medicines were only marginally helpful. We pushed ourselves to drink fluids to keep the sputum thin. (When you are not well hydrated the sputum is thicker and it's more difficult to cough up). Without orange popscicles, "Simply Lemonade," and hot tea with a spoonful of honey--I don't know how we could have made it through.

Three weeks after our H1N1 we were still bringing up phlegm, clear like yours, but annoying. Just good old-fashioned self-care with as much rest as possible got us through it. Having been through this virus it's easy to see how people with complicated medical conditions are vulnerable to a bad outcome if they catch it. One must be strong enough to cough well to get through this difficult virus. Even in robust health at the start, my husband and I were not 100% for at least 3 weeks after.

While I'm commenting, I want to add that as I mentioned in my article above, my liver enzymes were affected and I suffered jaundice and severe malaise during the illness. This search term also brings lots of traffic (from EVERYWHERE) to this article. Still we who have been affected in this way must be quite a minority as the media certainly doesn't mention that aspect--perhaps it's a good thing to avoid more public fear.

R. Elmi--back to the issue at hand. Have you had a touch of asthma in the past? Are you a current smoker? If asthma has troubled you and the cough is not allowing you do participate in your normal daily activities, it may be that you need an inhaler or some medications to help your lungs cope with the tailend of the illness. Certainly, I understand you have no primary physician. That makes it difficult. Not knowing all the details of your situation makes it hard to brainstorm in this regard. Some quick thoughts: If your employer has an employee health office--seek advice there--get them to listen to your lungs at least and perhaps offer you guidance on local clinics where you can be seen. Also, call your local health department to inquire from them regarding a physician you can see. I'd recommend the Emergency Department only as your judgment guides you--if you seem to be getting much worse and having a hard time breathing, etc.

If you click the "influenza" tag on the blog article it will take you to previous posts I made about the influenza in general and about Swine Flu. There are links and advice on those articles that may not tell you anything you haven't already learned about this illness, but then again, you might find a good tip that will help you feel better.

Wishing you much luck and hope you feel better soon,

Pushing fluids

Anonymous said...

My son had the swine flu and pneumonia at the end of October. He still has the horrible cough. He has had multiple antibiotics, courses of Prednisone, and other asthma meds, and it just won't go away!!

KSM said...

Like others, I found this blog via an "H1N1 lingering cough" Google search. Like Anonymous' son (Dec. 28, 2009), I've had a lingering cough & wheezing with treatment via antibiotics, two courses of Prednisone, and asthma inhalers. And, like the son, it just won't go away! I've thought about asking for a referral to a respiratory specialist, but don't know if that makes sense. Each time I visit my primary physician, she says that the CDC recommendations have changed a bit, so it sounds as if medical professionals are learning as the disease progresses. I recognize that medicine is as much an art as a science, but I would really, really like to be rid of these lingering after effects! Any thoughts on the referral idea? Or do we just need to tough it out? Thanks in advance for your thoughts.

Carolyn Cooper, MPH, RN said...

Hi, KSM, Good question and depending on the length of time you've been suffering from the after effects--a referral to a pulmonologist just might be worthwhile--or at least it might prove reassuring . . . I urge you to call your doctor's office, speak with your doctor's RN or LPN to pose this question--easier than getting direct to the MD and gives him/her an opportunity to contemplate the question and not give an impulsive answer.

STILL this is the most-read part of my blog. From literally ALL over the world people are wondering the same thing that you are, KSM, as the key words most used are "lingering cough after H1N1." As a side note also STILL the key words "elevated liver enzymes" keeps popping up regularly.

Antibiotics won't kill a virus, such as H1N1, but are effective against bacterial infections that could possibly take advantage of one's weakened condition. So for straight H1N1, no surprise that they have brought you little or no improvement.

All this being said, those of us who endured a severe case of H1N1 while being in robust health to begin with are certainly fortunate to have been able to tough through it and it sure shows why this illness can result in dire consequences to those who have underlying weaknesses to begin with.

God bless everyone reading as they heal from this!

Skim said...


It was good to read your article concerning your experiences with the H1N1 virus.

Although the hype around this virus has dropped off from the media somehwat over the last year, from my experience I know it's still very much around!

I am a 41 year old male and (was) in good health, caught the odd cold but never had anything like Flu, until now. I first started with aches/pains at the beginning of March which quickly moved onto coughing (up yellow phlegm), bad headaches and a constant high temp circa 39 C. This high temp latest 10 days! To be honest after day 6 I was starting to get worried, however NHS direct assured me this can last upto 10 days. Strangely I had no sore throat, or running nose.

The cough persisted and although I started to feel better by the 12th day I coughed up small spots of blood which prompted me to get off to the Doctors fast. I was prescribed amoxicillin and floxacillin antibiotics for 7 days to help clear up the chest infection. By now my chest was starting to really hurt through coughing - my ribs, chest bone mostly on my rightside. On the 19th day I was still coughing up yellow.brown mucus and one other time streaked with blood. Back to Doctors who said blood with mucus can be due to infection. I was now put on Doxycycline and sent off for Chest X-ray.

26 days later and I have just finished my last course of antibiotics. I am STILL coughing up phlegm (yellow to white now), although. My coughing during the day is reducing (mostly in the morning)and apart from my painful ribs I do feel better! However, my Xray results showed up possible infection (still!) and I have to go and see a chest specialist and another xray in a week to rule out anything else. It may also be that the chest infection is viral rather than bacterial.

I am completely take aback on how long and how severe an impact this type of flu can have on you. For me March 2011 came and is now mostly over, yet I didn't see any of it being in bed most of the time and I'm still not 100% yet. Everyone is different and this I guess affects each person individually. For me and my family, I just want to get back to normal and to stop coughing!!

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Mamma Rabbit said...

Hello Carolyn, I think your blog on H1N1 probably saved my life. I am a medical doctor in India, and we have been hearing of the H1N1 cases here for the past 3 months. Being aware of the gimmicks our pharmaceutical companies resort to for increased sales, my fiends and I thought the reports were exaggerated to increase vaccine sales prior to their expiry in April 2015. I developed a nasty flu on 1st March that I thought was a viral infection my husband brought back from a conference in Delhi. I had fever, 102-103, a persistent cough that was initially dry, body ache, bone pain, chills, and rhinorrhea, all of which I attributed to a viral fever until day 5 of the fever. By day 6, I had a greenish gray sputum that was very difficult to cough up and by evening I noticed pinpoint blood spots in the sputum. I was concerned and Googled up greenish sputum and H1N1; found a few write-ups, but none presented a patient's perspective as yours did. And I realized you had left-sided conjunctivitis just as I had. I called my OB/GYN (I'm 33 weeks pregnant now) and went in for an evaluation. I have started antibiotics for the sinusitis and acute otitis media that presented on days 5 and 6, respectively. The sputum and cough are still persistent and a major discomfort. If not for your blog, I would probably have considered this a particularly virulent viral fever and continued symptomatic and supportive care at home. Thank you for posting your experience and helping us.

Carolyn Cooper, MPH, RN said...

Thank you kindly (Dr.) Mamma Rabbit for sharing your story. All of the reader's comments with their shared experiences have added value to this blog article. Please be gentle to yourself as you convalesce from this illness as you know it saps your energy. Wishing you much joy with the baby to come. May you all be blessed.