My bout with dengue fever

January 17, 2013

“DEET up!”

That was my mantra while traveling in Laos last summer with my husband, Daniel, and our 11-year old son, Jonah. They’d wanted to go to Maine, but I wanted exotic. I won.

Nonetheless, after poring over Web sites on health risks in Southeast Asia before the trip, I became obsessed with a mysterious illness claiming the lives of scores of Cambodian children that made headlines right before we left — and with dengue fever.

I lived in fear of Jonah contracting some dreadful tropical disease (my mother would never forgive me) and insisted that everyone slather on insect repellent and cover up, despite the oppressive heat, to keep those dengue-bearing mosquitoes at bay. My pleas, though acquiesced to, were met with eye rolls from my kid.

Oddly, I never thought I’d be the one to get sick. But one night in Nong Kieu, a sleepy riverside town several hours’ ride from anywhere, I woke up shivering. Cold to the bone, I huddled beneath every layer I could grab. Then the sweats began. It slowly dawned on me that I had a fever. I woke Daniel. “I think I’m sick,” I said. He felt my forehead, hid his alarm and brought me two Advil — as it turns out, exactly the wrong thing to do.


(Ben Wiseman for The Washington Post)

The next morning, I rallied and made it to breakfast. But back in the bungalow, I had an overwhelming desire to get prone and didn’t leave my bed for two hours. I soldiered on — mustering strength to take a bus back to Luang Prabang, the tourist mecca, where I sat beside a waterfall and watched the tourists splash around.

Over the next few days, I stayed in our hotel room as my fevers came and went, my appetite disappeared, I developed gastrointestinal symptoms and I felt increasingly weak and queasy. I marveled at my lethargy and lack of ambition. On day three, I managed a short flight to Siem Reap, Cambodia, and dragged myself around Angkor Wat at sunset, barely noting its wonders and exhausting myself in the process. I did, however, take note of a sign outside the Children’s Hospital about a dengue epidemic and the need for blood.

By day four, I felt sufficiently sick and concerned to reluctantly seek medical attention. For serious illnesses, the guidebooks for both Cambodia and Laos steer you away from the nonexistent or substandard medical infrastructure and advise betaking yourself to Bangkok ASAP. I had my own visions of an ER in Cambodia: throngs of moaning, bleeding people, waiting amid gore and squalor and used syringes to be seen by untrained attendants completely unschooled in Western hygiene and lacking any modern medical equipment. But at least in Siem Reap, Lonely Planet’s assessment and my image of health care couldn’t have been farther from reality.

My husband found the Royal Angkor International Hospital, which Lonely Planet and the hotel staff had mentioned, endorsed on TripAdvisor. The lobby was spanking new, spotless and empty but for one expat. Within one hour, I was seen by a doctor, had blood drawn (by an English-speaking nurse skillfully using sterile equipment) and was going over test results with the doctor. To my shock, he explained to Daniel with great urgency and somewhat gruffly that my blood tests confirmed dengue fever and that I should check into the hospital immediately.

Dengue is a leading cause of death and illness in the tropics and subtropics, with 100 million people infected annually. The disease is spreading rapidly around the world; now, 1 of 6 tourists returning home from the tropics with a fever has dengue.

Treatment options are limited. The dengue virus attacks your blood, so as the disease progresses, you run about a 5 percent risk of hemorrhaging — as blood thinners, Advil and aspirin only increase the risk — or going into shock. Or you can recover. Hospital stays entail mostly monitoring — fever, blood pressure, platelet and white blood cell counts, fluid intake and the somewhat predictable course of the disease. Short of a transfusion, nothing can halt the assault on your blood or ameliorate the telltale rash or joint pains (dengue is also known as “breakbone fever”), both of which, mercifully, I was spared.

I couldn’t have picked a better place to have dengue. Affiliated with Bangkok Hospital, Royal Angkor caters to foreigners; unfortunately, most Cambodians, with an average annual income of only about $800, can’t afford the rates. The staff and doctors speak flawless English. The private rooms are clean and large, with bathrooms, balconies, cable TV and phones. Most importantly, of course, the care was superb.

For the next five days, nurses tended to me every four hours like clockwork: taking my temperature and blood pressure, changing my IV, administering compresses, Tylenol and sleeping pills and offering reassuring words and pats. They responded to call buttons within seconds. They brought in delectable-looking Asian meals (catered by a nearby hotel) and gently prodded me to eat. But since I’d developed a characteristic bad taste in my mouth and had no energy, I ate nothing. They took blood daily, and my Thai-trained doctor came promptly at the appointed hour to review my chart and examine me.

With a much better bedside manner than the admitting physician, this doctor patiently answered questions and outlined the course of the disease; he assured me that plummeting blood counts notwithstanding, my recurring fevers would abate in a few days, my strength would eventually return and I would fully recover. What U.S. hospital could boast such a reliable, attentive, knowledgeable and organized team of medical experts? Certainly, none for the price: less than $600 a day.

Throughout my stay, my family heroically handled paperwork and sat with me for hours on end, making occasional forays into the city and to temples. Truth be told, my boy was quite content to watch unprecedented amounts of TV in air-conditioned comfort, ride tuk-tuks back and forth to the hotel and help me maneuver my IV instead of traipsing among the ruins in the heat. For the most part, he refrained from making fun of my “piggy eyes” — fluid retention being yet another unpleasant symptom of dengue.

I was released after five indistinguishable days, marked only by calls from my sister and the presence of my spouse and kid, flipping channels and playing games. When my fevers stopped and my platelets began to rise from a frighteningly low level, the doctor declared that I was on the mend and could fly home. I asked whether I could do something to show my gratitude to the fabulous nurses. He said decidedly not; they were just doing their jobs.

Back in the States, I quickly regained the 10 pounds I’d lost. My lethargy and headaches gradually resolved after a few weeks. Shockingly, my insurance claim of $3,000 — documented with meticulous detail in the records I was given upon discharge — was also resolved within weeks; although I’d bought traveler’s medical insurance, my own primary insurer deemed dengue an “emergency” and covered the bill.

For a follow-up with my primary physician (who understandably wasn’t very familiar with dengue), I waited hours for a blood test and four days for the results. They were delivered in a 30-second voicemail, later followed by an incomprehensible letter: The gist was that my liver function was nearly back to normal.

Just when I thought that I could finally put my dengue experience behind me, two months after the first fever in Laos, my hair started falling out — a common side effect that no one had mentioned. More significant, if I get dengue again, my odds of getting hemorrhagic complications increase dramatically.

Now my mantra is, “Next summer in Maine.”

Rosenberg is an environmental consultant and writer in Washington.

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