Prompt Treatment Pulls Girl Through Flu (The News Journal)
Wilmington, Delaware
Monday, October 26, 2009 @ 04:09 PM EDT
by: HIRAN RATNAYAKE • The News Journal
No one is allowed into Cari Brunelle's home until they scrub their hands with sanitizer.
It's the rule.
There have been no exceptions since Brunelle's 10-year-old daughter, Jordan, spent much of this month recovering from a serious bout of swine -- or H1N1 -- flu.
"I just don't want to take the chance," the Wilmington mother said. "I want to err on the side of caution."
Before she got sick, the fifth-grader at St. Ann School had no underlying health problems that would make her more susceptible to the virus. She is an active child who goes to dance class twice a week.
But Jordan got so sick that her temperature reached 105 degrees. She lost about 10 percent of her body weight and spent five days in the Alfred I. duPont Hospital for Children in Rockland. She missed nearly three weeks of school.
Brunelle and her husband, John, wondered if their daughter would ever recover.
"It's hard to watch your child go through something like that and have such a high fever and become as sick as she was," Cari Brunelle said.
| Swine flu hits only a small percentage of patients as hard as it hit Jordan, experts say. Most people suffer a milder form, with symptoms including a fever and cough, runny nose, chills and body aches. There also can be vomiting and diarrhea. Typically, the symptoms begin to let up in 48 to 72 hours, said Dr. Karyl Rattay, director of the state Division of Public Health. On Monday, a record 230 patients flooded A.I. duPont's emergency department, though only three of the 111 children with influenza-like illnesses were admitted. Most had mild symptoms and were sent home. Across the country, swine flu has led to the deaths of 76 children since April, when it first surfaced in the United States. In contrast, the regular or seasonal flu kills 46 to 88 children a year. | SWINE FLU WARNING SIGNS In children
|
It is not known why children are more susceptible than adults.
"That's what makes it novel," Rattay said. "It doesn't behave like the typical flu."
Karen Hunter of the federal Centers for Disease Control and Prevention said there is no "concrete answer" about why children are more susceptible to complications from the virus. She said older people may have some residual immunity that children don't have because they were exposed to similar viruses decades ago.
"There's a fine line between hype and reality, and the reality is this is much scarier than the seasonal flu," Cari Brunelle said. "For me, there's not an overhype about swine flu. When you look at the number of deaths in children, it's a different beast altogether."
Odyssey of an infection
Jordan was well aware of swine flu before she got it.
"I remember that it came here from Mexico and that I needed to wash my hands and keep my hands to myself so I wouldn't get it," she said. "I never thought that I would get it."
She went to bed feeling fine on Wednesday, Sept. 23. Then she woke up the next morning with a stomachache and sore throat.
Cari Brunelle put her hand on her daughter's forehead and it didn't feel overly warm, so Jordan went to school as usual.
Throughout the morning, her stomachache got worse. After art class in the late morning, Jordan went to the school nurse, who called her father.
John Brunelle took Jordan to her pediatrician the next day, a Friday, and was told her symptoms were likely due to a virus spreading through the community. There was no discussion of swine flu, he said.
He was told to make sure Jordan got a lot of rest and to take her to the emergency room over the weekend if her condition got worse.
It did.
By Saturday afternoon, she had vomited numerous times. Her temperature reached 105 degrees and her parents began noticing other warning signs: Jordan was having trouble breathing, wasn't drinking fluids and wasn't interacting. She continued throwing up.
"The throwing up was the worst part because it hurt my stomach," Jordan said.
Cari Brunelle put Jordan in the back of her SUV and headed to A.I. duPont Hospital. Though she's not much taller than Jordan, she had to carry the girl into the emergency room because Jordan was too weak to walk.
Doctors took a nasal swab and eventually confirmed swine flu.
Jordan was given a chest X-ray, supplemental oxygen and intravenous and nebulizer medication. Hours later, she was admitted.
Dr. J. Jeffrey Malatack, chief of the division of diagnostic referral specialties, oversaw Jordan's treatment. He diagnosed her with viral pneumonia. Compared to other viruses, swine flu is more likely to travel deep into the lungs and cause viral pneumonia. Malatack said he was concerned that Jordan's case could lead to bacterial pneumonia, which is more dangerous.
"There are lots and lots and lots of cases of swine flu, but the vast majority don't end up getting admitted," Malatack said. "From that standpoint, she was more severe than most."
Malatack said there are many potential reasons for why Jordan got so sick. Among them, her immune system could have had a more vigorous response to the virus. Or, she could have been mildly sick before the virus hit her, causing her to become very sick.
"There are innumerable possibilities, so it's not even worth speculating," he said.
Treatment -- and prevention
Jordan took Tamiflu, an antiviral medication, twice a day during her five days at A.I. duPont Hospital.
As a precaution, her parents and 2-year-old sister, Grace, took one dose of Tamiflu daily for 10 days. Cari Brunelle was "terrified" that swine flu would strike Grace, who has asthma and other respiratory problems.
"All along, my fears of the swine flu before Jordan got it were fears for Grace because she was the one with the breathing trouble," she said.
Jordan, who weighed 70 pounds before she got sick, lost seven pounds. She hardly ate during her first 10 days back home.
Eventually, her appetite and energy returned and she went back to school Oct. 13.
"Lots of people seemed happy and excited to see me," she said.
About the only remaining indications of her illness are the balloons and cards from well-wishers that decorate her bedroom. She's almost caught up with her schoolwork.
"It feels really good to be better," Jordan said. "I hope I don't get that sick again."
Cari Brunelle doesn't believe anything could have been done to prevent Jordan's illness from getting so bad. If they had taken Jordan to the emergency department the moment she started to feel ill, she would have been sent home because at the time she had only mild symptoms, Brunelle said.
"I don't think anyone has to be hysterical about swine flu, but they should know that one child could have it mild and another child could end up like Jordan," she said. "There was a big difference in the way she was the first few days to the way the virus progressed so rapidly."
She recommends that parents keep a close eye on their children and react quickly if they get worse.
"If something changes, go to the ED [emergency department]," she said. "Move quickly."
modified: Wednesday, October 28, 2009 @ 12:44 PM EDT
created: Monday, October 26, 2009 @ 04:12 PM EDT
About Nemours
Nemours, one of the nation’s largest pediatric health systems, is dedicated to achieving higher standards in children’s health. Nemours offers an integrated spectrum of clinical treatment coupled with research, advocacy, and educational health and prevention services extending to all families in the communities it serves. Starting with Alfred I. duPont’s bequest over seventy years ago, Nemours has grown into a multi-dimensional organization offering personalized clinical and preventive care focused on children.
Nemours owns and operates the Alfred I. duPont Hospital for Children in Wilmington, Delaware and major children’s specialty clinics in Delaware (Wilmington), Florida (Jacksonville, Orlando and Pensacola), Pennsylvania (Philadelphia and Bryn Mawr) and New Jersey (Atlantic City and Voorhees). Having recently received preliminary approval from the State of Florida, Nemours will establish a new full-service children’s hospital as part of an integrated pediatric health campus in Orlando. KidsHealth.org, the world’s most visited pediatric health care Web site for parents, kids and teens, is a project of Nemours.
Nemours employs over 4,400 individuals, including 430 pediatric physicians, specialists and surgeons who cared for approximately a quarter of a million children in 2007. The organization’s goal is to align with parents, physicians, community leaders, children’s advocates and elected officials to ensure optimal wellness for every child. Additional information about Nemours can be found at www.nemours.org.
