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Monday 13 January 2014

The Perils of Living In Asia

I had planned to write my New Year's message but was posthumously detained by the unceremonious arrival of dengue fever on the 4 January 2014.  Bitten between the 28th and 31st of December 2013, this is the first time I have ever experienced the kiss of an Aedes mosquito.

The raging fever took hold on the night of 3 January 2014 at around 11.30 pm.  By morning I was a complete wreck but I had no idea it was dengue; thinking that it might be influenza or something that I ate the night before that was not agreeable.  Fortunately, my sister called and mentioned the 'D' word and so it was off to the hospital.

Singapore had the highest ever number of dengue cases in 2013 with over 22,000 but only 7 deaths reported.  Malaysia has double the victims but the death rate is more than 10 times.

Problems in Singapore can be blamed on over fogging making the Aedes mosquitos immune to the cocktail of chemicals spewed out by the fogging machines.  In Malaysia, according to my doctor all the hot spots start with an 'S' - Selangor, Seremban, Sabah and Sarawak.  The reason?  Too many construction.  These sites are a magnet for the Aedes to lay their larvae.

Except for the uneasy feeling that one dengue carrying mosquito might be lurking around, there is nothing to fear.  But being knocked out for over a week is no laughing matter. 

Government hospitals are better equipped to deal with this that private hospitals.  I went to Assunta hospital because the government clinic operated from Monday to Friday.  We forgot, the A&E is fully available on weekends. 

The doctors at Assunta worry about platelet counts falling below 100 and will admit you if it does happen.  They seem able to diagnose dengue infection day 1. 

At the University Hospital, the parameters are slightly different - they will not admit you even if the platelet counts falls to zero.  I guess you do not need coagulating agent unless you are so unfortunate as to cut your hand or run over by a passing vehicle.  They worry more about the haematocrit count (the volume % of red blood cells in blood) as the higher the count, the increased danger of dengue shock syndrome. 

Haematocrit count in men is normally 45% and 40% for women.

I am told by UH that identification of dengue serology is only possible a few days into the fever.

The above table tracks the result of my blood test together with the cost.  Assunta, being a private hospital have significantly higher charges.  UH is actually free, as the government credits all money paid.  I claimed back RM$53 yesterday.

I had two pints of hydration on Tuesday as the platelet count was in free fall and the haematocrit count was leaping. 

The haematocrit count continued its ascent post being cleared of fever on Friday.  The critical period is the 24 to 48 hours after the fever has subsided.  The itchiness, caused by the fluid leaking into the capillaries started in earnest on Friday and lasted until Monday.  Luckily, I have been able to recover without developing into full blown hemorrhagic fever or dengue shock. 

It is important to drink at least 3 liters of water/fluids for speedy recovery.  Also watch out for irregular heart beat, forced breathing, vomiting and stomach pains, these are not good signs.  The occasional gum bleed or nose bleed is acceptable.

I would recommend UH over Assunta anytime as the doctors at UH have on balance, much experience in patient care of dengue victims.  I suspect, the sheer number of cases gives them that experience.

20 years ago, dengue was never a problem. 

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