Just a quick post on a common illness: acute, viral gastroenteritis. Several viruses make seasonal appearances in our community and now is one of those times. This is a brief post because it’s now my turn: I’ve got the barfies!
Wednesday, 8:47 p.m.: Home from a meeting and my stomach is feeling weird. I didn’t like the food at the meeting, and didn’t eat very much. “Eat,” my body tells me, so I grab some peanuts and water. In retrospect, that was a good choice.
Thursday, 6:20 a.m.: I’ve hit the snooze button twice now after a good night’s sleep. Gotta get up and get going. I feel a small wave of nausea as I sit down to my breakfast of granola with strawberries and milk, and a cup of coffee. The nausea subsides but my tummy is rumbly….
8:38 a.m.: I arrive late to work. The rumbling signified the need to extend my time in the bathroom. Now in the office, the stomach has calmed down and the nausea is only mild. “I can do this,” I tell myself (and any sympathetic ear who will listen).
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Acute, viral gastroenteritis (AGE) is caused by several different viruses that arrive on our pediatric doorsteps at different times of the year. Rotavirus classically is a late fall and wintertime virus. It is so common most children in the U.S. have had this virus before the age of five) and so severe at times (worldwide, the diarrhea and dehydration from rotavirus continues to be cited as a major cause of death in children) that there is a very effective vaccine we give to infants by mouth at 2-, 4-, and 6-months of age.
You may have heard of norovirus. It’s been in the news lately for sickening passengers on cruise ships. The enteroviruses are most common in the summertime and go by some other names like echovirus and coxsackievirus (of hand-foot-mouth fame). One strain of enterovirus recently passed through California — acting eerily like poliovirus (another type of enteric or intestinal virus) — leaving some children with possibly permanent paralysis. (Those of you who know me have seen the difficulty I have moving my shoulders and arms. That’s a result of getting sickened by one of these enteroviruses ten summers ago. The leftover disability will not improve. A virus did this to me!)
The viruses that cause AGE are very, very contagious and occur at every age. Obviously, infants, children and adults with chronic medical conditions, and the elderly are at higher risk of having more severe symptoms. In the summer, some babies will have a touch of diarrhea and that’s it. (Breast milk is clearly protective for infants, especially in their first six months.) Other babies will develop more severe illness with enterovirus, including viral meningitis.
The treatment of vomiting and diarrhea illness is really trying to feed through the illness. Special formulas and foods are often not recommended. Sometimes we ask parents to try giving a store-bought rehydration solution like Pedialyte. If you think your child is vomiting excessively, having too much diarrhea, has blood in the stool, notice a marked decline in urine output, or can’t drink enough to keep up with their gastrointestinal fluid losses, then, by all means, CALL US!
AGE is sometimes called the “stomach flu,” but what it’s not is influenza. The infection we immunize for every fall and winter is perhaps one of the worst upper respiratory infections you can imagine: sore throat, congestion and cough, high fever and chills, body aches and headaches. What I’ve got today is not influenza.
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12:17 p.m.: I don’t know which virus I have, but it’s really starting to have the best of me. My last morning patient canceled (I seldom say this, but, thank you!). I finish my paperwork and head home (I work half-days due to the disability I described).
12:30 p.m.: My car is running on fumes. So am I. I need gas. My car, that is. Already feeling chilled, the four minutes it takes me to complete the transaction leaves me shivering. And I’ve got to find a bathroom! I… can… make… it… home…
12:51 p.m.: Barely made it. I make a peanut butter and banana sandwich, though I’m not hungry. My dog emerges from his crate in search of a banana treat (his favorite). He accepts this gift, gives me one look, refuses my attempt to pet him, and goes back into his crate! (This is the same dog that practically attacked me with love and concern when I suffered a facial laceration last month!)
1:25 p.m.: I’m lying under a blanket watching CNN. Malaysian Air Flight 370. Gripping news, isn’t it? I’m fading, and feeling really cold. Here comes the fever. I make it up to my bedroom to get a sweatshirt but the bed looks more inviting. My wife comes home, takes one look, and sighs. I’m apparently not a good patient. (You know the sound of the fog horn they blow at Consol Energy Center after the Penguins score a goal? That’s the sound of me throwing up. It’s that loud!) I get out of bed to use the bathroom and very nearly pass out with the attempt. Now I’m really nauseous and my head is pounding. Here comes the fog horn…
4:34 p.m.: I’ve somehow made it back to bed and fallen asleep. I clearly have a fever and my head is pounding. I can’t even think of eating or drinking anything. I know I need to make a decision about calling off from work tomorrow morning, and I need to make the call now. I call the office for guidance regarding Friday’s schedule. Mary makes the call for me: “You’re sick, stay home” (“for godssake,” she wants to say)!
6:15 p.m.: Good call. I try a cup of tea. Back to bed for me. But first, I’ve got to run….
8:32 p.m.: Apologies to my patients and parents who will need to be rescheduled tomorrow. Also, my apologies to my colleagues in the office who will need to pick up the slack left by me staying home. We do this for each other from time to time, and it makes me grateful to know I work with some very fine and compassionate people. I’ve made the right call to stay home tomorrow. I’ll get better faster this way and won’t pass this virus along to my patients and staff, even as I know where I picked it up in the first place! It’s a dangerous job sometimes!