When Mom Gets Chicken Pox

When my stomach started aching terribly this summer, I had a few amateur diagnostic theories on what was wrong: First, I wondered if I had inherited my mother's notoriously cranky intestinal tract. Then, as the pain grew more intense, I imagined the scar tissue from my two Cesarean sections somehow strangling my organs. And, when the pain got so bad I ended up doubled over on the dining room floor, I considered the worse: "I'm dying," I thought. I called my husband and begged him to drive me to the hospital.

"You have appendicitis," the emergency room physician told me. "You're kidding," was my response. The appendix wasn't on the list of terminal possibilities I had pondered from my gurney as the pain killers kicked in. For starters, the piercing pain that sent me to the ER was at the center of my gut; not the right side, where I'd always heard a bad appendix makes itself known. And truth be told: I'm at the tail end of my forties. Everyone I've ever known who had their appendix out -- my mother, my husband, one of my son's classmates -- had the obsolete organ extracted before their 12th birthday.

As my surgeon pushed me down the hallway toward the operating room, I protested I was "too old" for an appendectomy. "Oh, no, you're a baby," he assured me. "Yesterday, I took one out of a lady who was 80."

Despite years of experience reporting and writing about health, I had been clueless about what was wrong with me. And as I recovered, the reaction of some family and friends made me realize some shared my naiveté. "Your appendix?" a neighbor said, as she arrived at my doorstep with a thoughtful get-well meal. "I thought that only happened to little kids."

Doctors tell me they often get the same reaction when diagnosing illnesses and conditions adults tend to associate with childhood: Chicken pox, tonsillitis, pertussis (or whooping cough), measles and appendicitis top their lists.

And ironically, many of those conditions tend to beat up the average grown up more than the kids on the sick block. Hence, adults may need to pay a little more attention -- and get help with interpretation -- when experiencing certain telltale symptoms.

"Kids are a little more resilient and tend to recover a little more quickly," says Dr. Zane Saul, chief of infectious diseases at Bridgeport Hospital. "When you get to be approaching 50, your immune system begins to decline. You don't fight things the same way you used to."

Which is why adults with unusual or nagging symptoms -- say a rash or persistent sore throat -- should seek the advice of a skilled primary care physician, says Dr. Shari Vadel, a specialist in internal medicine affiliated with Stamford Hospital. "A lot of adults tend to seek out specialists for their symptoms, but as internists we think of things broadly and are used to diagnosing a wide range of illnesses." For example, Vadel, who practices at Primecare Medical in Stamford, says she might look at something her adult patient thinks is a rash and "immediately realize it is chicken pox or shingles." In the case of my appendicitis, Vadel notes that many patients erroneously believe -- as I did -- that the enflamed organ makes its trouble state known on the right lower quadrant of the abdomen. "That is true, but in early stages of appendicitis (the pain) can start in the center of the stomach, where you felt it, eventually radiating out to the lower quadrant."

Meanwhile, adults need to review and update their medical histories with their primary care doctors to prevent some illnesses they may initially dismiss as kid stuff. Recent statewide outbreaks of pertussis (whooping cough) and measles, (including reports of an infected adult traveling on the Metro-North commuter train), are examples of the critical need to update or boost immunizations, notes Saul. "We tend to be very vigilant about these things as kids, but as for adults, both the patient and the medical community tend to be a little bit lax."

Whooping cough is a serious concern for adults who care for -- or just spend time around -- young children. "Infants can get really sick from it," Saul says, "and while it isn't necessarily tougher on an adult, we have a responsibility to protect others from the infection."

Chicken pox -- which can be extremely serious in adults -- can also be prevented with vaccines, adds Vadel. And while vaccinations in adults and children have made chicken pox outbreaks increasingly rare, Vadel notes, "For an adult who has not had chicken pox as a child, this is something you may really want to talk about with your doctor. A lot of people forget to bring it up." Pregnant women are at an especially high risk because chicken pox can make them extremely ill and potentially impact the baby.

As for tonsillitis, one of the reasons you don't hear about adults having them removed is because it's a tough surgery. "One of my daughters had hers out when she was 8 and I think she was eating sushi that day," Saul recalls. "When my 20-year-old had hers out, I don't think she could eat much of anything for several days."

Problems with tonsils tend to get worse with age, explains Dr. Michelle Marrinan, who practices with Greenwich Ear, Nose and Throat in Greenwich and Stamford. A tonsillectomy in an adult is a more challenging surgery than in a child because the natural scar tissue that builds up around the tonsils as we age -- especially in someone who has had a lot of infections -- makes the surgery more cumbersome. "The tonsils tend to be more encapsulated, the blood vessels are larger and there's more bleeding, so in general it just becomes a more difficult surgery," says Marrinan, who is affiliated with Stamford and Greenwich hospitals. "When you take out the tonsils of a 3-year-old it's easy, but with an adult, the conversation about whether to have them out becomes a little involved. If someone is missing a lot of work, has a lot of infections and is really miserable they may consider it, but we're also very cognizant of their health history." About 80 percent of Marrinan's tonsillectomy surgeries involve children, while just 20 percent are on adults. A weakened immune system, a history of bleeding and other medical issues may make adult candidates and their doctors think twice about the procedure.

One way to prevent some of these illnesses from wrecking havoc with our grown-up lives is to focus on healthy lifestyle practices and be vigilant about good practices that can lead to prevention. While the necessity of updating vaccines is an important discussion to have with a primary care physician during an annual physical, minimizing stress, eating a healthy diet rich in vitamins in minerals, regular exercise and good sleep all can help build your immunity. "But nothing beats good old-fashioned hand-washing for preventing so many of these things," Vadel says.

And of course, pay attention to pain. In the case of my appendix, I was fortunate. I got to the emergency room before mine burst. While I did have to recover from surgery, I was out of the hospital in a day, spared from complications from infection. "There's not a lot you can do to prevent appendicitis. It can happen to anyone at any age," Zane says. "The important thing is just getting to the doctor to get it checked out and not thinking that kind of pain is going to just go away." Or, that you're too old for it to happen. HL