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!

1.02.2017

Hand, Foot, and Mouth Disease in Adults: Feeling Sick (Part 2)

First read Part 1 here, if you haven't already.

On Monday night, December 26, I felt a little hot, especially in my face, and my hands felt a little itchy, but I thought I was just imagining things! Because adults don't usually catch it, and if they do, they're often asymptomatic, and I'd been so careful about washing my hands well. My neck felt sore that evening, from the inside, but I didn't think much of it, since that happens to me sometimes, when I sleep funny or am stressed out.

Because I had been thinking of staying over on Tuesday anyway, to see my step-nephew on Tuesday night, I offered to stay and babysit for my sick-with-hand, foot, and mouth disease-niece "N" all day on Tuesday. My brother-in-law and sister were going to try to find a babysitter for her for Wednesday and Thursday. (My sister was off from work again on Friday and Monday, and my parents were coming and could care for her on the following Tuesday and Wednesday, so that was all the coverage they needed.)

On Tuesday, December 27, I got up and no longer felt hot at all, although I had a slight headache that responded to caffeine and ibuprofen by disappearing.

My brother-in-law found a babysitter for half of Wednesday (I would cover the other half of the day) and all of Thursday, but when he told her what N was sick with, she backed out:
Bummer. The babysitter for half of tomorrow and all of Thursday backed out when she thought more about coxsackie. So I'm on all day tomorrow, too. I should edit now, while N takes her second nap of the day (yay! sick kid sleeping = win for everyone). Will attempt to start shortly.

That day, N was kind of cranky and cried a lot. She took one standard, two-hour nap a bit earlier than usual, and was so tired later in the day but wouldn't really sleep. She doesn't usually like to drink water, but she drank a lot of water all day. She didn't eat so much.

I babysat all day, and was very tired at the end of it. But I figured that was just what usually happened when you hung out with an active toddler all day, and posted this to Facebook:
Anyone who has a kid and ever gets any brain-intensive work done ever: you have all of my accolades! (You did before, too, but now I'm really tired and there's no way I'm copy-editing today and I have the same gig tomorrow.)

On Tuesday evening, December 27, I felt two small sores in the front of my mouth. Like canker sores. They were small. One was white. I don't often get things like this, and it seemed like it would be a huge coincidence if it wasn't related to my niece's HFMD. Also, my neck felt sore again, but, as I said before, that happens to me sometimes, so I didn't think much of it.

When I woke up on Wednesday morning, December 28, the tiny sores in my mouth were totally gone. However, in their place, I had a sore throat and a slightly worse headache than the day before. The headache sort of responded to caffeine, but then I ended up taking some ibuprofen and it went away completely. The sore throat hurt a little, like it feels as a cold is coming on. Not enough to prevent eating or drinking, just enough to make you go, "Huh, my throat feels a little achy and sore."

N was feeling much better on Wednesday than she had on Tuesday. She also didn't wake up at all on Tuesday night, for the first time in about four days. She was more interested in eating, and less upset by everything.

I was tired on Wednesday and feeling a little glazed-over, but still thought it was just childcare-related exhaustion. However, I was definitely counting down the hours from 8:30 am until my sister got home at 6 pm. I felt weirdly listless and bored. I continued to wash my hands obsessively, especially after diaper changes and before eating anything.

On Wednesday evening, December 28, I could have run for the 6:30 pm train home, but I kind of felt too tired to run. I had to pack, and I felt like it was a little bit hard to stand. Not like I was dizzy, just really tired.

We decided that I would not run to pack, but pack more slowly and someone would drive me to a later train, maybe one that wouldn't require transferring in the middle.

I packed my stuff up, and as I did, my face felt hot and I didn't feel good, but not in a specific way. Just in a "Huh, I don't think I can take a train and a subway and walk a block home right now." I considered sleeping over another night, but that also did not seem like such a tantalizing plan. My sister took my temperature; it was 99.3˚F. Or 99.6˚F. Her not-very-accurate forehead thermometer gave two possible readings.

My sister offered to drive me home, and I gratefully accepted. I felt like I was being a wuss for just having a low-grade fever. But as she drove me home, about a 45 minute ride, I felt increasingly nauseated and like every part of my body ached. I ached like I had the flu. I didn't think it was the flu, since I'd gotten a flu shot. My throat started hurting a lot more, every time I swallowed. On the ride home, I told my sister that my throat hurt, and maybe I should take some zinc when I got home, in case I was getting a cold. I also told her that I was really nauseated. She blasted the cold air for me, which felt good. My head started hurting again.

I dragged myself into my building and up to my apartment (in the elevator), and got right into bed. I felt too awful to light Chanukah candles and thought maybe I'd just wait until I felt less hot and nauseated and achey.

Well, that didn't really happen. So I got up and lit and posted to Facebook again:
Be it ever so humble, there's no place like home! First night of Chanukah that I'm home... Happy 5th night of Chanukah!

I forced myself to stay in the kitchen until the candles burned down, and tried to drink some water. I was very tired and achy. I had absolutely zero appetite and the idea of eating food made me vaguely nauseated. I still (!!!) wasn't convinced I had coxsackie, since I didn't have any spots on me and thought it usually started with a "real fever," and my temperature was only a little bit high, barely a fever.

After the candles had burned out, I got into bed, thinking I'd fall asleep right away, since I was exhausted. Instead, I alternated shivering and sweating for hours. I kept shoving the warm comforter off and then pulling it back on top of me.

At 2 am, I got out of bed, drank more water, and downed some Tylenol. (I didn't want to take ibuprofen on an empty stomach.) I hadn't taken Tylenol earlier (foolishly!), because my fever wasn't that high and I thought I would fall right asleep as soon as I fell into bed. Also, it hurt a lot to swallow water, the idea of swallowing water + hard pills was almost too much to contemplate. But at 2 am, it seemed like a good idea.

My throat hurt so much. Plus, the Tylenol didn't really help the sweats and shivers. Or the body aches. I slept fitfully that night and totally understood why my niece N had woken up crying several times in the middle of the night the previous Friday, Saturday, and Sunday nights! I had no spots.

Still, because of how awful I felt on Wednesday night, I decided to call that "Day 1" of HFMD.

Part 3 is here.

1.01.2017

Hand, Foot, and Mouth Disease (caused by coxsackie virus) in Adults: Background (Part 1)

Happy 2017!

I contracted Hand, Foot, and Mouth Disease (hereafter HFDM, caused by coxsackie virus) from my toddler niece (23 months old, hereafter referred to as "N," for niece) last week. I decided to write up my relatively mild HFMD experiences in case they are helpful to anyone else. Also, because I was sick at home for the worst part, not caring for children (having none of my own), I had some time to research all of this and now to write it up. Most adults who catch this from children are also caring for sick children, leaving them little time to write it up in (excruciating or not) detail!

There did not seem to be a lot of good information about adults' experiences with it, even though I now know that a bunch of my friends have caught it from their kids. (They shared their experiences with me privately.) One friend referred me to this helpful blog post from Sarcastically Yours.

Notes you should read:
  1. I am not a doctor or any kind of medical professional or a scientist. So nothing I write here should be taken as anything other than the perspective of a layperson.
  2. If you are sick, you should go to a doctor, not just look for advice on the Internet.
  3. This is only about coxsackievirus group A, which tends to cause unpleasant but relatively mild symptoms including Hand Foot and Mouth Disease, not coxsackievirus group B, which can cause many more serious, long-lasting problems. (See this or this for more on Group A vs. Group B.) Some of the most dire reports online are from adults who had coxsackievirus Group B strains.
Background:
So, N had a mysterious rash on her legs on Sunday, December 4, and was diagnosed with coxsackie, (a virus that causes HFMD), as well as walking pneumonia. However, her pediatrician, to whom my sister spoke the next day, said that it didn't sound like coxsackie. N took antibiotics for ten days for the walking pneumonia and it got better and the rash went away in a day or two.

On Monday, December 19, a note was sent home from daycare that a kid in N's class had HFMD, and that children with HFMD must be kept home until they got an all-clear note from a pediatrician.

On Friday, December 23, I came to my sister and brother-in-law and N's house to visit for the weekend, planning on going home on Monday morning, or maybe staying until Tuesday night to see my step-nephew, who would be visiting then. They live about two hours, give or take, from me, via public transit.

On either Friday night, December 23 or Saturday, December 24, we noticed a new rash on N's legs, starting on the back of her thighs. My sister's first thought was that it was a recurrence of the mysterious non-coxsackie rash from a couple weeks earlier. The skin there was dry, so also I thought maybe it was dry skin (I sometimes get weird stuff from dry skin in the winter), and my sister applied moisturizer.

N hadn't slept well on Friday or Saturday night, waking up and crying a few times. I was up and rubbed her back a few times on Saturday night, but she ultimately wanted her parents.

She didn't seem that hungry on Saturday, December 24.

By Sunday, December 25, it had spread to N's arms. N also didn't want to eat. She didn't sleep well that night, either, waking up a few times. (Like, she slept from 8 pm to midnight, and was up and wanting comfort/help/Tylenol at midnight and 4 am and then woke up for the day at 6:30 or 7 am. She's normally a 7:30 pm to 6:30 am solid sleeper.)

It seemed a lot more like coxsackie/HFMD and less like dry skin, even though she had no spots on her palms or the soles of her feet or inside her mouth. She didn't really have a fever or seem hot, but maybe that didn't rule out coxsackie/HFMD.

I posted this to Facebook on Sunday evening:
So, how contagious is coxsackie (hand foot and mouth) from toddlers to adults?

Answers ranged from: "I've been around kids who had it two or three times and never caught it" to "I caught it but it was mild and I heard that it's always mild when adults catch it" to "I caught it and it was awful" to "I caught it and it was awful and other adults I know who have had it have suffered a lot more than kids seem to." So...a lot of people haven't caught it when kids have had it, but those who have have caught it, either gotten very sick (more severe than their children) or not very sick (less severe than their children). In some cases, their children were pre-verbal, so it's hard to assess who had it worse, except for by comparing fevers and counting spots. One infectious disease specialist spouse of an acquaintance said that he thought 1-5% of adults-caring-for-children-who-had-it got it.

The upshot from my research and Facebook discussions seemed to be that there were two factors that work against adults catching it from children:
  1. It seems like a lot of adults have already been exposed to the virus as children, and that's why many don't catch it. They have already developed full immunity against it as a result of having had it, just like I had chickenpox when I was four and so now I can't really get it again.
  2. It also seems like many people who "catch" it don't actually get any symptoms from it. This means that many people "catch" the virus from children, when they are either children or adults, and develop immunity to that particular strain, but never get sick. So you could have "had" it as a child and never have known, or, as an adult, you could "catch" it from a child now and also never know. (Medscape says here that "More than 90% of coxsackieviruses infections are asymptomatic or cause nonspecific febrile illnesses." (Of course, there are lots of different kind of coxsackieviruses and not all of them are the same as the ones that cause HFMD. But, still. It seems that the same is true of the specific coxsackievirus that most often causes HFMD in the US, A16.)
Adults without compromised immune systems ("immunocompetent adults"), a description which fit me, are considered to so rarely get HFMD that there are medical journal articles describing cases where they do. (Open the individual journal articles at your own risk if you are easily disturbed by images of people with skin disorders. Many describe cases that were very severe and caused by enterovirus71, a strain that is common in Asia and rare/nonexistent in the US. The link itself just goes to Google Scholar and no images.)

There were also factors in favor of adults catching it from children:
  1. There are different strains of coxsackievirus, and catching one strain doesn't mean that you can't catch another one later. (Like a cold or the flu, which are also viruses.) But it might mean that you don't get as sick if you've ever had a different strain of it.
  2. So many of my friends seem to have gotten it as adults! Like, six or more people I know caught it as adults. I don't know what percentage of total-adults-I-know-who-have-been-in-contact-with-children-who-have-HFMD that is, though. (That could be 5% or less, for all I know.) No one who got it seemed too blase about it, although a few cases were self-reported to be mild.
I never had symptomatic HFMD as a child, nor did any of my siblings. Between those two options, it really seemed like I was unlikely to catch it and get sick from it, if that's what N had, and if I attentively adhered to good hygiene practices. I had been washing my hands the normal amount during my visit (i.e., after using the bathroom, before eating), but probably not for the full 20 seconds that you're supposed to soap up for and not always with hot water (sometimes with whatever temperature water came out of the faucet when I turned the hot water on).

By Monday, December 26, it had spread to more of N's body, including around the outside of her lips, but not really to palms or soles, and she didn't seem to have any sores inside her mouth or on her tongue. Back to urgent care. They said she had coxsackie. They said adults rarely contract it. They said that there was nothing to do but wait it out.

Once the diagnosis was official or maybe even before that (sometime on Sunday?), I started washing my hands more vigorously and for longer (20 seconds of soaping), with as hot water as I could stand.

Here's Part 2.