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.
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.