Diary of a cough

On or around 9 July, an innocent cough appeared, at first very timid, which didn't seem to be connected to anything. As the doctors say, it was unproductive. By the weekend, I was still coughing and now feeling slightly weak - but there was no elevated temperature.

Obviously this cough was worrying me enough by then to go to the family doctor (15/7); she examined me and listened to my lungs. "The lungs are clear", she said, "and everything else seems to be ok, although the throat is slightly red". As the weakness had passed, I was "released for observation" without treatment.

Nothing much happened during the next week, although I began coughing harder and harder; in fact, I would have coughing attacks at night which left me temporarily very weak. The cough was still unproductive. So I returned to the doctor on 23/7; she repeated her examination with the same results. This time she prescribed an anti-histamine (which would be intended to reduce any inflammation, not that she could see any) and a mucolytic agent (which would thin out the mucus and allow me to expel it).

Again, nothing much happened for a few days, although one night I had yet another coughing attack and felt that I couldn't breathe at all. Fortunately, I have the CPAP machine, which blows pressurised air into my nose, so I quickly put the mask on and started breathing again. The next morning I drove to Jerusalem in order to see an Ear, Nose and Throat specialist (this was the nearest clinic with the most immediate appointment). He checked me out and even performed an endoscopic examination (tube goes into the nose and down to the back of the throat) which was very uncomfortable, due to the local anaesthetics. There still seems to be nothing wrong organically.

The next few days - unfortunately, the weekend - were a repeat: coughing attacks which left me unable to breathe (or so I thought), with a wheezing sound. Most of these attacks happened at night, where I had the CPAP machine, but one happened when I was in the local supermarket; the manager was quite frightened by my performance (I too was frightened).

The piece de resistance was the Saturday night, when at a frequency of about once an hour, I would wake up, start coughing exceedingly violently and not be able to breathe. Of course, I wasn't getting any sleep - and neither was my wife. The attacks would end by my body trying to vomit - I did in fact vomit once on Saturday morning, when the two cups of tea which I had just drunk ended up on the floor. But generally these were only dry heavings. 

At about 3am, I had a brainwave: maybe I am suffering from side effects of the mucolytic agent. I checked the instructions which came with the tablets, and sure enough, breathing problems and vomiting were listed as possible side effects. I decided there and then not to take another of those tablets. At 4am, my stomach started rumbling, as if I were going to vomit once again, but I managed to control myself and so saved yet another attack. 

Later on during the day, I managed to snag an appointment with the family doctor (29/7) and tried to explain what had been happening since we had last met (by this time, I could hardly talk). She seemed disinclined to my theory that I was suffering from side effects; she tended to believe that I was suffering from reflux gastritis which can cause coughing (and I am technically a chronic sufferer of this, but I take a pill every day and so am asymptomatic). I tried to describe my breathing problems and unintentionally went into the same non-breathing loop there and then. It turns out that I was breathing - the wheezing was the automatic attempt to force air into the lungs - but not in a normal matter, and of course my freaking out wasn't helping.

The doctor ordered a chest x-ray (which I intend to do today; I don't know what she'll be able to see from an x-ray) and prescribed an antibiotic as well as increased dosage for the anti reflux gastritis medicine. 

A chance remark by a nurse in the clinic suggested to me that I might be suffering from whooping cough aka pertussis (as it happened, there had been an item on the news the previous evening about mothers refusing to let their babies be inoculated against whooping cough); when I got home, I started researching the subject. And what did I find?

The classic signs of pertussis are a paroxysmal cough, inspiratory whoop, and vomiting after coughing. If there is vomiting after a coughing spell or an inspiratory whooping sound on coughing, the likelihood that the illness is pertussis is nearly doubled. The incubation period is typically seven to ten days in infants or young children, after which there are usually mild respiratory symptoms, mild coughing, sneezing, or runny nose. This is known as the catarrh stage. After one to two weeks, the coughing classically develops into uncontrollable fits, each with five to ten forceful coughs, followed by a high-pitched "whoop" sound in younger children, or a gasping sound in older children, as the patient struggles to breathe in afterwards (paroxysmal stage). Fits can occur on their own or can be triggered by yawning, stretching, laughing, eating or yelling; they usually occur in groups, with multiple episodes every hour around the clock. This stage usually lasts two to eight weeks, or sometimes longer. A gradual transition then occurs to the convalescent stage, which usually lasts one to two weeks. This stage is marked by a decrease in paroxysms of coughing, both in frequency and severity, and a cessation of vomiting.

I think that my symptoms match the bill: the slow build up, the paroxysmal cough, the whoop, hourly episodes. Whether I do actually have whooping cough (ie a bacterial infection) is irrelevant; I do have the symptoms and I certainly have the 'whoop'. Knowing this made coping slightly easier: I don't get totally stressed out when an attack occurs (although the paroxysm is exceeding unpleasant and slightly painful) and know that immediately after, my body is trying to breathe. I have worked out a repeated arrangement of cough, clean mouth/spit, breathe, which seems to do the trick. Also, I am now actively removing as much of the mucus/phlegm from my body as I can, which should help.

I have to sleep in a chair with my back raised so that the mucus doesn't drown me, a position which is hardly conducive to sleep. I awake after maybe an hour for a coughing attack which lasts maybe fifteen minutes; then at least another fifteen minutes go by before I am calm enough (and my mouth clean enough) to try to rest again. As a result of all the above, I'm only sleeping a few hours every night - and of course, this sleep is not continuous and so not useful.

During the day there are fewer episodes - mornings seem to be less problematic - so I manage to get some work done (of course, I haven't traveled to work the past few days). I generally feel almost all right, although very tired. I daren't lay down for a nap, for if I do, I will wake up with a coughing attack. I have to be very careful about what I eat - adding wheat germ to yoghurt is a very bad idea as the small grains stimulate my palate which causes me to cough.

Today I hope to do the chest x-ray and tomorrow I will return to the doctor. It looks like I will have to conduct my side of the examination via a mobile computer as I can barely talk (physically talking seems to encourage coughing attacks). The quoted passage above doesn't give me very much hope - the paroxysmal coughing stage can last eight weeks! Of course, I may not have whooping cough, in which case this stage should be shorter.

[Edited 13/09/12 - a few of the final paragraphs have been revised and rewritten]