“Karim was 10 months old when he caught the chicken pox virus. At first it was just a few spots on his tummy, but it soon spread to a rash that took over his whole body; his head, his face, even his eyelids. I rushed him to the doctor, who confirmed it was a bad case of chicken pox, but said there wasn’t a lot that could be done other than to wait for it to get better and treat the fever with pain killers and the itching with creams. I felt so helpless not being able to do anything to help my little boy. With hindsight I now know that the doctor could have prescribed him an antiviral medicine, but unfortunately he wasn’t given any. [See fact-box below for information on treatments for chicken pox]

"That night Karim woke up screaming in pain. His fever was 40 degrees and the pain-relief medication was doing nothing to help. I held him close and just lay there on the floor with him all night, trying to ease his suffering. Eventually I took him to the hospital again, but the doctor insisted there was nothing unusual: “It’s just chicken pox,” he said, and told us to go home.

"Now this was one of the best-known and best-regarded hospitals in Dubai so I knew I should listen to the doctor, but I had a gut feeling that something was really wrong. I begged them to keep him in for a night at least, as he needed lots of fluids to combat his fever and he wasn’t accepting any. Thankfully they agreed.

"Two weeks later and Karim was still in the hospital. Since they admitted him he'd had a constant fever and didn’t seem to be getting any better; every time his temperature reached 41.5 degrees the nurses would give him painkillers and antihistamines. They were managing his symptoms, but there was no attempt to treat the root cause of it.

10-month-old Karim at hospital in Dubai

"The nights were the worst. It wasn’t just that the fever would spike, but the amount of pain he was in was indescribable. He would scream in agony until the painkillers kicked in. Day after day the situation seemed to be getting worse and we didn’t know what to do, we thought it just needed time, but time wasn’t healing him. I was torn between being with Karim and looking after his younger brother; my husband and I would take day and night shifts. I would go home at the end of the night to prepare his brother’s lunch, allow myself to cry, drop the little one to nursery and then head back to the hospital for my ‘day shift’ with Karim.

 

"The hardest part was coming home at night. The house was so quiet, and yet deafening in the absence of Karim"

"I would seem to hear Karim all around the house, his voice and his laughter, his screams and his cries. I also missed spending time with his brother terribly and felt so guilty for not being able to be around for him. We were in Dubai during the summer with no family around but with a few good friends who supported us till the end.

'What I saw made my legs tremble'
"One morning when I went to the hospital I found Karim asleep. This wasn’t unusual so I just waited for him to wake up, but hours passed and he was still sleeping. The doctor said it was normal as they were giving his antihistamines so he could relax and not scratch himself. When he finally did wake up he wasn’t himself; he was drowsy, just wanting to sleep more, he wouldn’t interact or eat or drink anything. It was at this point that I felt I had to do something. My instinct was telling me something was wrong. I thought that maybe if I gave him a warm shower he might revive and wake up. I removed the bandages they had wrapped around his body to prevent him from scratching and what I saw made my legs tremble.

"His whole body was red and swollen. His hands, stomach and feet looked as if he had a small balloon under the skin. I tried to make him stand up but his legs were like jelly – he had lost sensation in both feet and all the skin in between his toes looked as if it had been burnt.
I put him back into bed with my heart racing. I was on the verge of having a panic attack, but I thought ‘I need to be strong, I need to be there for him, there’s no one else to be there for him but me’. I alerted all the doctors and they ran biopsies, MRIs, brain scans, heart scan, liver scan, and endless blood tests.

Karim had sepsis, a life-threatening condition

The diagnosis
"When the results came through the next day we found out that Karim had septicemia, or sepsis, a life-threatening condition cause by the body’s immune system going into overdrive to fight an infection, reducing blood supply and potentially causing multiple organ failure. In Karim’s case the infection was caused by staph bacteria entering his body through the chicken pox lesions. It was terrifying to me that if I hadn’t decided to remove all the sheets wrapped around him and to wake him up, no one would have had noticed what was happening.

"If I hadn't done anything, no-one would have noticed what was happening"

"The Infection had started on his skin, then spread to his blood, and then to his bones and joints. It often can reach the heart too, but fortunately it hadn’t yet in Karim’s case. It was incredible to me that all the time Karim had been suffering in hospital, writhing in agony and burning up with fever, the bacteria had been growing and none of the doctors had noticed or seemed to care.

"Our ordeal continued. The doctors started a course of treatment for the bacteria and Karim had to undergo daily scans. I really can’t describe how I feeling at that time. I was heartbroken, torn, hopeless, and I had no idea what the future had in store for us. I would leave the hospital to see his brother with tears in my eyes and prayers in my heart, so many prayers. I wanted to collapse but I kept telling myself to be strong. I had to have courage to face the doctors and make sure they were giving Karim the attention he so desperately needed.

Read more: 'The Mother Switch: how your hormones turn you into super mum'

A mother's intuition
"One day it occurred to me that, since the infection had made him numb from the hips down, could it be that the bacteria had settled in his spine? I’m no doctor but this seemed to make sense to me, but when I suggested it to the medical staff they just ignored me. Karim was scheduled to have a full body MRI to check which parts of his body were mostly affected. The first hour passed, then a second hour, and by the third hour I started to panic as I anxiously waited outside the door for news. I was so worried that I ended up pressing my ear on the door to find out if I could overhear what was happening. The last thing I heard was: 'We are sending the images to the radiology department urgently, please check what’s there on his spine'.

I closed my eyes then and willed myself to stay calm, hoping that perhaps I had misunderstood. Finally the doctor came out and asked us to have seat. “Your son is not well,” he said. “I’m sorry. We don’t know if he’s going to make it. If you can discharge him from the hospital and put him in another one it would be best for him. The bacteria has spread to his joints,  hands, feet, stomach and his spine.”

When I heard 'spine' I lost it. All I remember is jumping out of my seat, shaking the doctor, ripping off his tie and his useless gown. 'It’s all your fault,' I screamed. 'I was telling you all last week about his spine and you wouldn’t listen! You were not listening to me!'

That’s all I recall, shouting and losing my temper.  His reply was: 'I’m so sorry ma’m but you know you could have lost your son.'

"I had a total breakdown and nothing would stop me from crying."

How could I have left my son  with them? What had they done to him? I so missed him and wanted him back with us as a family; his brother missed him, his father missed him, the house, our souls missed him. How can the heart of a mother survive seeing her son in a situation like this?

Flying to Lebanon
The next day we discharged him from the hospital and flew to Lebanon our home country where the doctors said they were able to treat him. I had to carry him on my chest the whole flight as he was unable to move from head to toe. My heart was shattered to pieces as I also had to leave my other son in Dubai with his father since they were unable to travel with me at that time. We flew on an emergency basis and went straight to the hospital where the procedure was again traumatizing: more scans, blood tests, admissions etc.. I overheard the doctors say, ‘he’s a lucky boy to have had made it through’.

Karim stayed in the Lebanon hospital for two and a half months, finally getting the proper treatment. It wasn’t easy, but at least we knew deep down that there was hope and the medical staff would do anything to rescue him. It wasn’t easy having to live in a hospital for months, but I got used to it.

Karim recovering in the Lebanon hospital

Once we were discharged Karim’s recovery period was also tough. It took him a while to learn to eat again, walk, move his joints, and adapt to the outside world. Every part of his body was deeply affected. It was almost like he had been born again and I had to walk with him step by step until he was on his feet again. His treatment also continued after he was discharged from the hospital; he was on several different antibiotics per day, and I had to give him injections three times a week to strengthen his immunity and protect him from any other infection.

Now, two years later, Karim has stopped his treatment and we just go for checkups every now and then for the joints that are still a bit affected by the infection. For the most part he has now completely recovered and my heart couldn’t be any happier or more thankful. He’s a happy and healthy kid and has proved himself to be a total fighter and a warrior. He’s my superhero, my source of strength and happiness. He taught me that life changes to be harder sometimes, but what hurts you today makes you stronger tomorrow. He has given me so much wisdom throughout his unfortunate journey, I learnt a lot of things about life, people, love, pain, and most of all: prayers. Prayers do wonders.

Spreading awareness
"I wanted to share our story because sepsis only happens in 2% of chickenpox cases. It’s very rare, which means that even medical staff might not think of it. I think all mothers should also be aware that sepsis can arise not only from a complication associated with chicken pox, but if bacteria enters the body through any scratch, bite or cut. If not treated early it can sometimes silently lead to further infections. I also want to highlight the need to vaccinate against chicken pox. Karim wasn’t vaccinated as he was only 10 months and the chicken pox vaccine is due at 12 months, which was very unlucky. But most of all, I want to say to other mothers out there: always trust your instinct. When you feel that something is not going well, then it probably isn’t. I have heard the saying 'A mother’s intuition is worth more than a medical degree,' and , in our case, my intuition helped me save my son’s life.

I pray that no one else goes through half of what Karim has gone through. He might forget about it, but I never will. I still have flashbacks, every night they roll through my memory like a movie scene.  May all our kids’ days be filled with lots of health , laughter and beautiful memories to cherish."

Dina and her older son Malek, 6, and Karim, now 4


NEED TO KNOW: SEPSIS
Sepsis, also known as blood poisoning, strikes an estimated 30 million people per year, is more common than heart attack, and claims more lives than any cancer, yet even in the most developed countries fewer than half of the adult population have heard of it, according to the World Federation of Pediatric Intensive and Critical Care  

Saving lives depends on early recognition and awareness of sepsis, and a better understanding of sepsis as the final common pathway of illness due to infection is essential to drive improvement.

What causes Sepsis?
Sepsis is caused by an infection when microbes enter the body through a cut in the skin. Most types of microbes can cause sepsis, including bacteria, fungi, viruses and parasites. Normally, when we suffer a minor cut, the area around the injury swells and becomes hot and red. This is the immune system in action. Sepsis is  this process in overdrive: inflammation is no longer localized to the "cut", but is now widespread affecting all of the body’s organs and tissues. The body´s defense and immune system go into overdrive, leading to widespread inflammation, poor perfusion, organ failure and septic shock.

What are the symptoms of Sepsis?
The diagnosis and treatment of sepsis often is delayed because early symptoms are not recognized by patients, health care workers and physicians. A common feature of patients with sepsis is that they feel sick as never before. In children the signs and symptoms may be subtle and deterioration rapid. The most common warning signs of developing sepsis are:

• Fever, chills

• Rapid or difficult breathing

• Elevated heart rate

• New confusion, disorientation or drowsiness

• Severe muscle and joint pains

• A sense of impending doom

• Skin Rash

• Poor feeding (infants and children)

Sepsis and chicken pox
However, although it is important to be aware of sepsis as a possibility, if your child has chicken pox or another common childhood illness, it does not mean he or she will also get sepsis. We asked Dr Mudit Kumar, Consultant Paediatrician & Specialist Neonatologist at Mediclinic Welcare Hospital, about the relationship between sepsis, staph bacteria (which caused the sepsis Karim suffered from) and chicken pox:

"The most common complication of chickenpox in previously healthy children is bacterial infection and Staph bacteria is one of the most common as they can be normally present  on the skin of children. Most of the time these infections are superficial, but there is a risk of the bacteria invading the bloodstream which is facilitated by disruption of the skin barrier and when these bacteria enter the blood stream it’s called septicaemia, or sepsis." 

What is the usual treatment of chicken pox? Is there anything that can reduce the likelihood or an infection?
Chickenpox is a self-limiting viral disease so usually no specific treatment is required, apart from the fever control and symptomatic treatment for cough and cold associated with it. For skin lesions nothing should be used in the initial stages when the lesions are still erupting apart from keeping the skin clean by regular baths, however when the blisters start to dry up and they become itchy then some moisturizing cream can be used.

There is a medication called acyclovir ( brand name: Zovirax) that can help shorten or combat the varicella infection if it is started within 24 hours after the rash develops. This medication is not necessary for everyone who develops chickenpox. However, it may be appropriate for people who are at risk of developing a more serious illness, such as:

Adults

Children older than 12 who are unvaccinated

Children of any age with chronic lung problems (such as cystic fibrosis) or chronic skin conditions (such as eczema or atopic dermatitis)

Children of any age who must take steroid medications (also called glucocorticoids) or aspirin on an ongoing basis

Children or adults with a weakened immune system, including transplant recipients and people with HIV

Acyclovir can be taken in oral form or as an injection. It is generally well tolerated but can cause stomach upset or headache. To reduce the risk of infection the most important preventive measure of course is the vaccination against chickenpox which is now done universally in most of the countries including UAE. The vaccine is given as an injection at 1 year and again at 4 years age of age.

High risk individuals who are exposed to the chickenpox can have varicella zoster immune globulin (VZIG), which is given as an injection within 10 days (ideally within 4 days) of chicken pox exposure. This agent reduces complications and the mortality rate of varicella, not its incidence. High risk groups include:

·         Immunocompromised children and adults

·         Newborns of mothers with varicella shortly before or after delivery

·         Premature infants

·         Infants less than one year of age

·         Adults without evidence of immunity

·         Pregnant women

 How common are serious infections of chicken pox?
After the introduction of vaccine, the number of complications in children dramatically declined, although the most common complication has remained bacterial superinfections. The common complications include skin and soft tissue infections (42 percent), dehydration (11 percent), and neurologic complications (9 percent)

 What are the signs of a staph bacteria infection?
Staph bacteremia frequently occurs in association with fever and other symptoms related to the source of infection. Bacteremia - Also known as blood poisoning, bacteremia occurs when staph bacteria enter a person's bloodstream. A fever and low blood pressure are signs of bacteremia. The bacteria can travel to locations deep within the body, to produce infections affecting Internal organs, such as brain, heart or lungs

 How can you tell if chicken pox may have become infected and when should you start to worry?
Usually chickenpox lasts for two weeks.  After being exposed to the chickenpox virus, you will begin to show symptoms about two weeks later. This period following exposure and preceding the onset of symptoms is called the incubation period. You can start spreading the virus during this period, starting two days before you show signs of a rash. You remain contagious until the last of the bumps have completely scabbed over. During this time, persons with chickenpox should avoid contact with others who might be susceptible. This may mean staying home, away from other children and adults.

With simple chickenpox there will be fever, some cold symptoms and rashes.

But if any of the signs and symptoms mentioned under septicaemia are noticed then you should be seen by the doctor immediately.

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