Saturday, October 24, 2009

Flu: Deadly Lessons Learned

Sorry I haven't posted in awhile. I contracted [lab confirmed] swine flu (I have asthma) . Within 22 hours of onset of symptoms, I was unable to stand, moving less than half the air I normally can, high fever with confusion, in shock, and with a low oxygen level. I was brought to the ER by my wife and admitted to hospital. If I had not gotten to the ER that night and had instead gone the next day, I would be in ICU right now instead of writing these words.

I made mistakes in my prepping plan. Some of these mistakes could have cost me my life. I want you to learn from my mistakes. I list what went wrong, what went right, cover home care, and then list some advice I got from the hospital staff to help you all keep from ending up a statistic.

What Went Wrong
Too many trips outside the home. We live about six miles outside of town in a sparsely populated area. So limiting exposure to the "herd" is easy for us. But I did not plan trips to town efficiently, making about 60% more trips than actually needed, thus increasing my exposure to potential infection. Worst of all, I visited a house where a child had been recently ill with a respiratory infection without masking up while I was there. Even though I was there only a few minutes, it would have been enough to expose me to a disease.

I didn't pay attention to good hydration. When the disease manifested,, it came on with bad nausea and severe coughing. Initially, I could replace the fluid lost by drinking some water. But as the severity of the coughing itself induced vomiting, I stopped drinking water completely. Within a few short hours I began to show the symptoms of dehydration as I lost ever more water through coughing, sweating, tears, and vomiting. With the high fever, my falling oxygen saturation, and confusion I was soon beyond being able to save myself by drinking water. My wife should have forced me to take small sips of water as often as possible, but her concern for not causing me further suffering won out. In the event, the ER staff had to run 3l of IV fluids into me before the shock lifted. Dehydration can be a killer, get water into the patient as often as you can, even if it is only a tablespoon at a time.

No oxygen available in my house. I have asthma and used to have a home oxygen unit. But I never replaced it when we moved to Montana. I required oxygen in hospital for about 20 hours off and on. If I had oxygen available in my home, I would not have arrived at the ER in such desperate shape. Maybe it might have even given me the edge to be able to realize that I was getting shocky from fluid loss and got me drinking water again. Having a pulse oximeter available would have allowed us to monitor how well the bronchodialators and oxygen were working for me.

A decent oxygen rig can be assembled for about $220 that will allow about 2 hours+ at 3l/minute flow rate, enough to help a flu patient. Aviation oxygen is "OTC", medical oxygen (100% rather than 99%+) is by prescription.

What Went Right
Our IC plan works. We have a good supply of earloop medical masks and some N95 "rubber banded" masks available as well as ample supplies of gloves, disinfectants, paper towels, etc. So my wife was able to disinfect the house after I was admitted to hospital and I was masked when I was taken to the ER, thus cutting the chances of me infecting others.

I am in strict quarantine for 10 days; it was an easy matter for us to turn the master bedroom suite into our "prepper quarantine ward". I only need to leave it to eat, having masked, washed my hands, and gloved up. I spend only the minimum time outside the isolation room and wipe down everything I touched/handled with disinfectant before I return to my room. My wife is masked when she is in our home and we keep the CDC recommended distance of six feet apart at all times.

Could This Have Been Handled at Home?
I have a rescue inhaler with a spacer. In hospital, and for the next week or so, I require frequent nebulizer "breathing treatments". Using the puffer inhaler instead of a nebulizer would be less efficient and deliver much less medication than the nebulizer would. So it might have taken two days to even start to improve my breathing capacity. Plus, my puffers would have run out within a day and a half at the heroic dosing levels that would have been necessary. I might have been able to do it if my wife could have gotten more inhalers.

Without an oxygen tank, the shock would have worsened some more , I would have been unable to help myself for a longer period of time, and the risk of death would have increased. If I had just a little D cylinder with a nasal cannula, I would have improved some and the real risk of death would have been lower.

I had some prednisone on hand, though at a lower dose than used at hospital, so I was covered on this. I have a penicillin and a macrolide antibiotic on hand so I might have been able to treat the bacterial pneumonia that started up, though the hospital used a quinilone antibiotic. So I had a chance of treating the incipient, potentially deadly complication of bacterial pneumonia. I had a small supply of antiemetics to treat the nausea so I had a chance to slow the deadly fluid loss that would have killed me.

If my wife had forced fluids on me, an ounce or so at a time, I would have had a small chance of recovering from the developing shock. I was down nearly three quarts of water so it would have required round the clock intensive nursing care on her part and a lot of luck to correct the deadly fluid deficit. Between the shock, the low blood oxygen/seriously impaired respiration, and incipient bacterial pneumonia, I probably had about a 65% chance of surviving this flu with home care only.

Notes on the Disease
First, in our area of SouthWest Montana, there have been no cases of the seasonal flu at all, only H1N1 (swine flu) to date. Silver Bow and Lewis and Clark Counties lead the state in case reports, for week ending 17oct09, (1,501-3,000 cases each), with Galatin County close behind (751-1,500 cases). Generally, Eastern and Western Montana counties are reporting between 1-250 cases. Central Montana counties and Broadwater County are reporting 0-0.9 cases.

Montana's Department of Public Health has received the first shipment of H1N1 vaccine, they are deciding which groups to offer it to first. Watch your local newspaper and TV for further news. So get your regular flu shot but exercise meticulous infection control behavior in your family to avoid H1N1 infection. I had had the regular flu shot 8 days before I came down with the swine flu, maybe I became lax in my precautions? Here is the flu information page for our State.

The doctor told me that the H1N1 virus is transmissible by indirect means (infected person touches object, you touch object with germ and then touch your eyes or nose) also, not just by the infected person coughing or sneezing droplets that you inhale. As an added note, pets should be excluded from the infected person's room as their fur can serve as a "fomite" to carry the virus between people. The infected person could pet the cat or dog if the person washes their hands thoroughly before hand or wears gloves. But no nuzzling by the animal or kissing by the human. Imagine trying to sanitize a cat after the patient coughed and then pet it!

The virus is shed for up to 10 days after the patient's fever breaks. This means the patient is still highly infectious even after they feel fine again. So wearing a mask when out in public and using hand sanitizer or gloves frequently is not only common courtesy for the recovering H1N1 patient, it is sound public health policy. All door handles, light switches, etc. need to be disinfected regularly during the course of the patient's illness and the whole area given a thorough cleaning and disinfection after the disease has passed.

This strain of flu is highly infectious; consider it as infectious as measles or tularemia if that helps give you the mental image that this is not a trivial disease. Pregnant women, young adults, and those with chronic diseases (diabetes, heart disease, chronic respiratory disease) are at real risk of death from this flu strain.

Use masks! Sure it looks funny in the USA but in Asia it is a social custom to wear a mask when you are ill with the cold or flu as a courtesy to others and as a good public health practice.

N95 masks tend to have higher breathing resistance and be less comfortable to wear than procedure masks. But they offer a slight edge in risk reduction. Earloop masks are the easiest masks to wear for long periods of time, just remember to form it to your face carefully. Traditional string-tied masks tend to have more "breathing room" so they would be a good choice for the patient as they have low breathing resistance. There downside is that they take more time to don and doff and tend to shift position easily.

That's all for today. I'm glad I'm still alive and I hope you can learn from my mistakes so you don't end up in serious crisis due to the H1N1 flu.


Kymber said...

MT_Serval - i am so sorry to hear about the seriousness of your illness - thank goodness you went to the ER when you did! All of our thoughts and prayers will be with you and your family and we will pray that you recover from this illness and come out even stronger in the end!

Thank you so much for sharing your personal experience and for teaching us all of what you have learned!!!

Please make sure to get better soon!

American Trucker said...

Wow, sorry to hear you had to go through this, Thank God you made it and are getting better, maybe these are lessons we can all learn from. We think my wife might have the flu which means more than likely I have it too. I'd like to repost this on APN as it's good advice for all of our readers.

Eileen said...

Glad you pulled through. I also have asthma so I read your post with great interest (passed on by Nomad's blog). Listen, I'd urge you to research the issue of using your puffer "a lot" as opposed to the nebulizer. I had a situation a few years back when my asthma had progressed to the point that I frequently was out of breath, where I used the albuterol puffer a few times a day. I developed a cardiac situation that ended up with me getting EKGs, a halter monitor, all sorts of craziness. They couldn't find the issue (because I wasn't using the puffer that week!) and it was a mystery why my 30 something year old heart was freaking out. A few months later, I read the connection between cardiac symptoms and albuterol inhalers, asked the doc and she exploded - you're using it HOW often?!? Well, that got me a nebulizer, which she said I can use every few hour without having my heart go nuts. I do, when I'm sick and yes, it does speed my heart but the whole irregular and stop beating issue stopped. Something to do with the the dosage and method of delivery.

So, please check into that before you take to abusing the puffer as a cheaper or easier alternative. In my case, they also put me on Advair which has virtually eliminated the asthma and I discovered I was gluten intolerant and between the two, I can run, bike, dance, hike, sing, and climb stairs like a champ now. But asthma is always there...

Anonymous said...

I am in health care and will add some tidbits about hydrating when drinking even an ounce of water, or gatorade sounds impossible. A teaspoon of water or gatorade, powerade or Pedialyte every ten minutes. This may seem daunting but compared to dehydration is it that much of a big deal? No. You may increase that to a tablespoon as you progress. Of course you don't have to go through all of this if you can actually drink an ounce or more, but knowing this should help you all when you wonder how much and how often. Water, even though seemingly inert, is tough on the tummy. Keep some of the above products in the home so you odn't have to make a trip to town. Yes, some of us live 30 or more miles away form the madness!

Anonymous said...

Please forgive my spelling errors.

Badrockbilly said...

While reading about your plight MT_serval I remembered a situation in the book "Survive the Savage Sea". When they ran out of water to drink while living on a raft in the South Pacific; the survivors caught rain water from their sail and since it was too salty to drink they injected the rain water in a rectal enema.

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