1.03.2017

Hand, Foot, and Mouth Disease in Adults: Getting Sicker (Part 3)

Here is Part 1.

Here is Part 2.

I made a post-hoc judgment call and decided that Day 1 of coxsackie/HFMD was on Wednesday, December 28. (That's described at the end of Part 2.) That's when I started to feel awful, even though it took another couple of days to get spots.

I woke up on Day 2, Thursday, December 29, feeling less hot and maybe slightly less achy all over my body. I took Tylenol as soon as I got up, on an empty stomach. The idea of eating was kind of repugnant to me. I was a little bit nauseated and not at all hungry. I...think I ate some yogurt that day? I spent most of the day in bed. I forced myself to get up every few hours to drink a glass of water. After the yogurt, I took some ibuprofen.

I posted this to Facebook:
Raise your hand if you are currently at home, sick in bed with some kind of mild illness that makes you feel awful. I know I'm not the only one. This is a post for complaining, even though we all understand that being sick in bed is not the world's worst thing, it happens to everyone, we are all grateful that our lives are generally good and we have roofs over our heads and beds under them, and access to appropriate medical care, food, and water. For those people who are sick and can't be in bed because you need to work or take care of your kids, you have all of my accolades. If you don't feel like complaining, there is no need to complain. Scroll on by! For those who are sick, I hope that you all get a lot of sleep and feel much better very soon!

I was very tired, but not at all sleepy, if that makes sense. That night, I wasn't hungry, but wanted to take ibuprofen on a not-empty stomach. So I very painfully ate some chicken and rice that my sister had sent home with me (thank you!), and (painfully) took more ibuprofen. The ibuprofen helped my sore throat a tiny bit, but not much. Tylenol did nothing at all for my throat.

I didn't feel hot or cold again until the evening, when the alternating sweaty and shivering thing happened again. I think it's called "fever and chills," but I don't know if I had a fever above 99.5˚F. It didn't feel good, though I think moderately better than it felt on Wednesday night! I think maybe Tylenol or ibuprofen helped this a little? I don't know.

The main feature was now my very sore throat and total exhaustion/lethargy/malaise. I still had no spots.

I woke up on Day 3, Friday, December 30 with a very painful sore throat, at 7 am. I think my throat woke me up. Drinking water made me want to cry, but I got up and choked down a glass of water and some Tylenol. I didn't think I could choke down yogurt. I didn't want eat anything at all. The thought felt repulsive.

I thought I might have strep throat, since my throat still hurt a lot, was unresponsive to analgesics, and I didn't have any spots at all. I didn't want to go into Shabbat without antibiotics if I had strep throat, regardless of whether I also had coxsackie/HFMD. (I still (!) thought I might or might not.) So I decided to go to urgent care.

I thought I should eat before I went to urgent care. I found some kefir in the fridge and drank it, with a lot of pain.

As I was getting dressed to go to urgent care, I saw a small spot on the side of my left-hand middle finger. It looked like this on Day 3:
Day 3, tiny raised spot on left middle finger
Day 3, tiny raised spot on left middle finger
My hands look kind of raw and dry, more than they usually do. I think that's because I washed them so vigorously with soap and water while visiting my niece.

Unfortunately, I had absent-mindedly scratched it a couple seconds before my brain kicked in and I realized that it might be a HFMD sore.

From my online research, I had deduced that the sores tend to pop up where one has skin issues, calluses, or abrasions. I had also deduced that it was best to avoid scratching them if one could. It wasn't even that itchy, just a little itchy, but right after I gave that spot a scratch, it kind of popped up and became more prominent.

I don't usually get random blisters on my fingers, and so when I saw this is when I first fully acknowledged that I had HFMD.

I still thought that I also might have strep throat, since my throat hurt so much. I had not heard of a 3+-day-long sore throat as being a feature of coxsackie/HFMD, although I later learned that a friend had a sore throat for a week. I looked at my throat in the bathroom mirror and didn't see any sores, just red, swollen tonsils. I also didn't feel any sores inside my mouth.

Off to Urgent Care I went! As I was walking there, the finger with this sore got a weird buzzy/numb/tingly feeling in it. That feeling came and went in this finger, but felt more weird than bad.

I felt hot and gross sitting there. I waited an hour and 15 minutes to be seen by a physician's assistant.

As I waited, I was absent-mindedly looking at my hands and saw a few more spots pop up, all on my left hand:
3 tiny red spots on left hand, at urgent care, on Day 3
Left hand, Day 3, at Urgent Care
You can see three of them here. They're honestly barely visible, but they're there. I might occasionally get one little red dot like this on occasion, but three seems like HFMD. My niece's red spots also looked like this, more or less. Red, not that raised, not that itchy. She had a lot more of them, but she also touched them more than I did.

There was also a fourth one (barely) visible on my left hand, from a side view:
1 tiny reddish spot on left hand, at urgent care, on Day 3
Left hand, Day 3, at Urgent Care
I made a very conscious effort not to touch them, which was not that hard, because they were not really itchy and didn't hurt. I don't think I would have had that kind of self-control if they had been itchy or hurt!

My temperature was 97.5˚F, which is a bit low for me. (I tend to run 98.6˚F when I am not sick, and feel truly awful at 99.5˚F, which for some people is barely a fever at all.)

The rapid strep test I had at urgent care came back negative. The doctor took a look in my throat and noted that it was "very red." He didn't see any spots inside there, anywhere, of any color. He was willing to prescribe antibiotics on the chance that it was strep throat (which he thought was likely), but I wanted to get a culture and check before taking any, since there was no point in taking antibiotics for coxsackievirus. So they took a second culture and I went on my way.

As I was walking home, I felt a blister on my foot, on my left arch. When I got home and took off my shoes and socks, I could just barely see a little white spot on my left arch, and also noticed a second spot elsewhere on my left sole:
Day 3, two barely-visible spots on my left foot
Day 3, two barely-visible spots on my left foot
I am prone to eczema when my skin is dry, so I put moisturizer that seems to prevent outbreaks of eczema on my hands and feet and did my best not to touch them. As I was doing so, I also observed a new sore between my big toe and second toe on my right foot. I've heard that they also appeared where one tends to get calluses, and I've gotten calluses on my left arch and a bit where flip-flops rub between my big toe and second toe. So I was not so surprised to see spots pop up there.

I also ate two Popsicles that night, which felt amazing on my still-very painful sore throat. I also choked down a schnitzel, which hurt a ton and felt like sandpaper on my throat. Drinking water was still very painful.

I got sweats and chills again that night, but not as bad as the previous night. I put moisturizing lotion on my hands again before going to sleep.

I had set up hot water for Shabbat, but the idea of consuming anything hot was...bad. I stuck with cold things, which seemed like a better idea given my throat pain.

I woke up on Day 4, Saturday, December 31, with the skin of my lips peeling off in a few sheets. It didn't hurt at all; it was just weird. I had been putting lip balm on my lips whenever I put moisturizer on my hands and feet, since I figured that keeping the skin protected and in better shape might help ward off sores or blisters. I've had chapped lips before, but this wasn't that. The top layer of skin on my lips was just peeling off. Oh, well.

I also had more spots on my hands and feet, and the spot on my left middle finger had increased in size a lot. It was now a large, fluid-filled blister, which I endeavored not to touch.

There was also a new, small blister on my right middle finger, where I have an old callus from years of taking copious notes by hand:
small blister on right middle finger
small blister on right middle finger
I also saw two small, slightly-painful sores in the front of my mouth, inside my upper lip, which looked a lot like the barely-visible sores that I had inside my mouth, on my lower lip, the previous Tuesday evening.

I found that the only thing that was comfortable to eat was cold, plain yogurt. I had 2% Greek yogurt. Putting a spoonful in my mouth and closing my mouth on it and letting it just sit there felt heavenly. I also ate two more Popsicles, which felt amazing.

I was extremely exhausted all day. I felt like I could barely move.

Later on Saturday, December 31, I found or felt sores on my back and abdomen, but they didn't hurt or itch. My throat continued to hurt a lot, and I had little-to-no-appetite. I kept forcing myself to down a glass of water ever so often. On Saturday night, I went to a grocery store and bought a loaf of bread, some bananas, chocolate pudding, more Popsicles (I was almost out), and ice cream. Sadly, ice cream did nothing for me. It was uncomfortable to eat and didn't help my throat or mouth nearly as much as yogurt or Popsicles did. Popsicles seemed like the gold standard for inflamed-mouth relief.

As I was out and about on Saturday night, my hands didn't feel great. They felt a little achy and swollen, although they didn't look swollen. My feet hurt. Since my Friday afternoon, post-urgent care photo, the blister on my left arch had gotten larger and fluid-filled, while the other one was mostly just larger and redder. I was unable to get an in-focus photo, but this gives some general sense of the state of things:
Day 4, larger blisters on left foot
Day 4, larger blisters on left foot
I did some research on Saturday night, December 31, and realized that there was less out there than I had hoped for adults with hand foot and mouth disease:
Friends who have had coxsackievirus/hand-foot-mouth disease as adults: can you please PM me your e-mail address if I don't already have it? I have some questions for you, which I think I may e-mail to you to spare everyone else the boring/gory details. There isn't that much info available online, and I knew that a few of you have caught it from your kids (as I have from my niece). Doctor at urgent care said what so many others have said, "It's probably just strep throat. It's rare for adults to catch it and there's nothing to do but wait it out." For anyone curious, Dr. Google (including PubMed) indicates that a strain of coxsackievirus that has become more prevalent in the US since ~2011 (A6), is not one that many Americans are immune to (not having been exposed to it as children), so more adults are catching it now. It has a more atypical presentation than the formerly common strain, A16. And it can be more severe, or maybe usually is more severe, but so far, nothing about mine seems severe except for the awful sore throat going on 72+ hours. (Still trying to rule out strep with a throat culture.) Happy Chanukah and Happy New Years, everyone!

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