The H1N1 Virus, Asthma, and a Severe Case of Croup

ava_h1n1_croupReaders of Raising Them Green may have noticed that I have been quiet for a week. My last post, H1N1 Season Begins and Tamiflu Dosing Errors Emerge, seems to have been a bit of foreshadowing. I have been out of commission this past week because my daughter was dealing with the H1N1 virus, asthma, and a severe case of croup.

My daughter went to school on Monday and enjoyed dance Monday evening. She was in bed by 8pm and at midnight she woke up with a severe sore throat. She had a slight cough and a low-grade fever. I had a surgery scheduled for Tuesday morning at 11:15 am to have a tube placed in my left ear (yes, I’m in my 30s and getting an ear tube place). As the time passed from midnight to 6:00 am when the rest of the house woke up, I knew that Ava was very sick.

Usually her fevers run high, real high. Earlier this year her fever was 106+ when she had influenza A. Her fever didn’t get very high that night but she was completely lethargic, which is uncharacteristic for her with a low-grade fever. At 7:00 am, I called the pediatrician’s office so we could get in for an appointment.

The kids’ pediatrician, who is a wonderful doctor and amazingly compassionate, is eight months pregnant. Pregnant women are one of the groups at high risk of complications for the flu so she masked up and then put a mask on Ava. She said that it sounded like the flu but she wanted to rule out strep. The strep culture was negative and so the pediatrician diagnosed Ava with the flu and wrote us a prescription for Tamiflu.

Now we knew that this was a diagnosis based on symptoms and not an actual diagnosis. The ped stated that the rapid flu test is not very accurate with the H1N1 virus, with some physicians reporting less than a 50% success rate. Since we don’t have the luxury of waiting until the non-rapid flu test to come back because of the window of opportunity for Tamiflu, she made the symptom-based diagnosis. In Arizona, all subtyped influenza cases are coming back as H1N1.

Despite Ava not feeling well, I actually made it to my surgery. My dad was able to watch Ava while my husband came and babysat me during my quick outpatient surgery. Ava and I slept the afternoon away. Her fever continued to stay low and her sore throat was her main complaint.

We both went to sleep early and about midnight, again, Ava woke up crying because her throat hurt “so bad”. Ibuprofen wasn’t helping with the throat pain but I managed to get her to fall back asleep. The next three hours consisted of me taking her temperature, counting her respirations, and checking her blood oxygen saturation. As a mom of an asthmatic, I’ve been educated on what a safe breaths per minute rate is and we have our own mini pulse oximeter.

Her oxygen levels remained solid, always above 95%, and her respiratory rate was a bit increased – 35-45 breaths per minute. However, she began to sound worse and her cough changed from the dry cough of earlier to the telltale bark cough associated with croup.

At about 3:30 am I decided that we needed to go to the ER, despite her good oxygen saturation. We got there and they quickly triaged her then we were sent to the waiting room to…wait. There were quite a few families there but the grandmother next to me said that it was much emptier than it was earlier in the evening.

Shortly after we arrived, Ava said she was “snoring in her throat” – that’s Ava speak for stridor. I took her back up to the triage nurse and her oxygen sat was 96. He said that if it got worse, we should come back to see him. Not ten minutes later it got significantly worse. She sounded horrible. So off we went to the triage station and her O2 sat came back at 99%! You could hear her stridor from across the lobby but her O2 was 99%.

The nurse commented that she was really pulling while breathing and retracting so although her sats were great, she was working very hard to maintain them. He called a pediatric ER nurse out and she listened to her chest and her throat and said she’d get us back as soon as she could.

About 20 minutes later we were called back, much to the chagrin of the tweenager next to us who had been waiting for more than four hours and had yet to see an ER physician.

The doc came in quickly and confirmed that Ava does have croup, a rather severe case. He immediately administered decadron and then set us up in a droplet precaution room for a racemic epinephrine breathing treatment.

The respiratory therapist came in and hooked Ava up to the nebulizer and pushed the racemic epinephrine through the machine with oxygen. Ava hacked and hacked but the therapist assured us that this was normal. Ava has had croup every single year since she was born (she’s nearly six) but she was never bad enough to need the epinephrine.

The doc described it as an epi-pen via nebulizer. He advised us that should she need a second treatment, she’d be admitted. He let us know that he expected her to be admitted, based on the severity of her stridor.

So after the breathing treatment we watched Little Mermaid, we watched Wizard of Oz, we watched Lady & The Tramp, and then Ava took a nap. Finally, finally, the doc came in and proclaimed that Ava was well enough to go home and sent us on our way with a prescription for prednisolone.

Thankfully, the rest of the week went well. Ava’s fever broke on Friday and her cough has tapered off, significantly.

{ 13 comments… read them below or add one }

Lisa October 4, 2009 at 4:32 pm

Not fun at all! I have asthma so I know your daughters pain. I think sometimes us with asthma know how to breath well when normally you shouldn’t be able to which is why our O2 will sometimes come back better than it really is. I was having a bad allergic reaction and knew my breathing was very bad but my O2 stats were fine in the the ER.

Hope she is getting a lot better. Oscillococcinum is great for flu and homeopathic.

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Alison Kerr October 4, 2009 at 8:45 pm

Melissa, I’m so glad that is over for you. Thank goodness for Tamiflu and for your parental instincts and your ability to react appropriately and get the help needed for Ava. I’m amazed that you managed to get your own medical needs taken care of in the midst of that – I don’t mind admitting that I’d have been a wreck!

I’m sending positive thoughts your way for a much better week this week. Is it a relief to not be worrying and wondering about H1N1 now?

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Wendy October 4, 2009 at 10:54 pm

Melissa, my heart went out to you and your family when I saw the photo of your little Ava, and then to read the account… you are a wise and brave Mommy! Know that you and yours are in my thoughts and prayers.

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Bethe October 5, 2009 at 7:56 am

Poor little thing. Glad she is on the mend. Thinking of you- Bethe

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brooke October 7, 2009 at 7:29 pm

Aw, I’m sorry you guys have had a rough go of it. I remember that croup cough so well…my brother got croup every year, 2x a year until he was 10 I think. It’s a horrible sound and must be so scary for those kids. She sounds like a trooper though!

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Kelly October 26, 2009 at 10:18 am

Wow! This story is IDENTICAL to what we just went through with our 8 month old son…sudden low grade fever, sudden VERY runny nose, coughing and sneezing. Doctor basically diagnosed him over the phone with the flu (they were advising all patients with flu-like symptoms to stay home unless they were severe). I thought to myself, “Ok, if this is H1N1, it’s not all that bad!”. But, in the middle of the night he woke gasping for breath, “barking” and a grayish-blue color. We rushed him to the ER, where we was diagnosed and admitted for croup. He is on the mend, but still very congested and “croupy”. Thanks for sharing Ava’s story.

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Melissa October 27, 2009 at 11:19 am

Hi Kelly,

Thanks for the comment on my blog. It is amazing the amount of traffic this post is receiving, a lot of people are searching for H1N1 and croup and reading about Ava’s story.

I’m glad that your son is doing better and I hope that his recovery continues and he’s back to normal quickly.

Warmly,

Melissa

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Shelley November 1, 2009 at 12:50 am

I just went through a very similar thing with my 5 yr old. She was recently diagnosed with croup and we are still monitoring things closely as she still has a low grade fever off and on. Has anyone heard of H1N1 being misdiagnosed as croup or vise versa?

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Melissa November 1, 2009 at 11:45 am

Hi Shelley,

Thanks for the comment on my blog. I hope that your daughter begins to feel better, soon.

Now I’m not a medical doctor but this is how both the ER doc and the pediatrician explained it to me:

Croup is a viral infection that is most commonly caused from the parainfluenza virus, however it can be caused from the influenza virus (including the H1N1 strain) as well as other viral infections. Croup is a separate infection from H1N1 and so a child can have both at the same time. Croup comes with the tell-tale bark cough and a croup diagnosis does not negate an H1N1 or other flu diagnosis.

Hope this helps.

Warmly,

Melissa

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Nicole November 16, 2009 at 7:53 am

Hi,

Thanks for your informative posts! My kids are both often getting CROUP and being treated with Prednisolone. Just curious, did you get Ava the H1N1 flu vaccine?

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Melissa November 16, 2009 at 11:18 am

Hi Nicole,

Thank you for your comment. I did not get Ava the H1N1 vaccine. She is allergic to eggs and so any flu vaccine is contraindicated. I hope your kids are feeling better soon!

Warmly,

Melissa

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candace fuller-quiring November 16, 2009 at 4:29 pm

my 4 year old son went into the emergency department on friday nov 13th because of flu like symptoms, they looked him over told us that he had croup and then sent us home. not even an hour later while he was sleeping he stopped breathing and was rushed back in to hospital via ambulance, hours, endless medications , tests and ten doctors later they finally realized that he had h1n1, . even though the doctor told me that she was 99.9% sure that he didn’t have h1n1.

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Melissa November 16, 2009 at 5:19 pm

Wow Candace, that is really scary. I hope he is healing and doing better now.

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