Monday, August 31, 2015

Down With Dengue

For those who dont already know, I was down with dengue fever early last month and was unfortunately complicated with a condition known as dengue maculopathy that affected my vision for the past few weeks. Thankfully, I had recovered enough now to be able to see, return to work and still do the things that I love doing.

Honestly, after attending to so many dengue cases in the wards, ICU and HDW, I had never really thought being down with dengue can be such a terrible experience. I mean, I know it is unpleasant and can be dangerous but most times, patients with uncomplicated dengue are the ones who recover fastest and can be seen smiling and eating away compare to the other patients, so it just never crossed my mind that it is actually so awful. But now I realized, being down with dengue especially with the presence of vomiting is enough to make you feel totally lethargic, lousy and loss appetite.

I started developing high grade fever with body ache and lethargy on a Sunday that was not resolved by paracetamol and with no other infective symptoms, I already got my suspicion on dengue fever. True enough, a FBC and NS1 test the next day confirmed my suspicion.

Aside from the frequent blood taking (imagined getting poke 3-4 times a day!!), my next biggest fear was developing life threatening complications from the dengue fever. After all, I had seen too many dengue patients requiring ciritcal care and some became so complicated it lead to mortality.

Well, during my initial febrile phase, the 'bone breaking' pain was the worse thing that got to me. The pain was so severe (I easily gives a pain score of 6-7 at that time) that it felt like someone was hammering away at every inch of  my bones and joints breaking them into tiny bits every second. No position whatsoever can relieve the pain and discomfort and I can't sleep due to the pain. Even topical patches could only took away the pain for very brief moments. Every second felt like hours of torturing to me. I was also losing appetite and I learnt that it actually took a lot of determination to force oneself to still take orally and drink plenty of fluids a day when you don't have an appetite and felt nauseous. My oral intake soon became even poorer when I developed vomiting and eventually I was admitted to the hospital.

I was put on IV drip for a day and with IV maxolon, I could drank at least 2 liters of fluids a day. I was still in febrile phase when I was admitted and it took almost a week before I went into defervescence. Upon entering defervescense, my appetite improved, the muscles and joints pain lessen significantly and things seemed to be going well until the morning of my second day of defervescence. I was awaken by their early morning routine vital signs taking and felt blurring over my bilateral eyes. Initially, I brushed it off thinking it was because the room was dark and I'm not seeing clearly from just waking up but when I tried looking at my own face in the mirror later, that was when I realized it was real. For a moment, I was shocked and scared because I thought I had became partially blind overnight. I couldn't even see my own face clearly and all I saw was a vague shape. Part of my visual field was total blurness.

A quick check with the opthalmo oncall MO affirmed that I probably got maculopathy as a complication from the dengue fever with edema seen at both my maculas and fovea area, thus the blurring of vision. I was subjected to more thorough opthalmo investigations the next day when clinic resumed and the OCT and FFA only further affirmed the initial diagnosis. There were also minimal tiny hemorrhagic spots (likely due to low platelet count) and leakage from the eye capillaries seen. My heart sank when I was told it usually takes about 1-3 months for recovery and there might be permanent residual effect of the blurness. I was hoping it would had resolved spontaneously within a week or something. I was started on high dose oral steroids in the meantime.

I was discharged once my platelet count showed increasing trend and hematocrit level went down and also because I wanted to be discharged badly already. It's getting depressing having to be hospitalized for a week plus regardless of whether it was a first or third class ward. In a sense, I felt lucky I managed to get a first class ward and  had a whole room to myself during the entire stay, else it might be even more depressing sooner. But still I guess no one likes hospital stay even though all I did was sleeping most of the time.

My vision gradually improve over time with improvement seen over my left eye first. During the initial days of developing the maculopathy, I could only see gross and large objects. Then little by little I can start to made out words although they are not completely clear. Going online or watching TV were more difficult because my vision was more blur against lighted background. I also got to be on "holiday" at home due to this as without a good vision, I was probably too dangerous for my line of work.

Among some of the lovely flowers and thoughtful fruit baskets that I managed to snap pictures of. Seeing fresh flowers really brighten up a patient's day :). Of course, I like to take this opportunity to say a huge thank you to every single beautiful person who had visited, sent me flowers , fruit baskets, fruits, chocolates and well wishes during this period especially when my vision was very much affected. Hearing about all your well wishes truly warmed my heart and makes the days in blurness more bearable and happier
Grateful to have a whole room to myself. I also like to thank all the ID, medical and opthalmo doctors, first class ward nurses and staffs of HSAJB who took care of me during my hospital stay. Thank you everyone once again. XOXO

Although my biggest fear of developing life threatening complications did not occur, I never thought I would developed such complication from dengue fever instead as dengue maculopathy is quite a rare complication (here in Johor). In fact, the opthalmologists told me I'm the first they came across with such complication. And it was during those times I can't see clearly I realized how much we had taken our perfect vision for granted most times. 

Looking back at this whole dengue episode, I don't deny I was sadden, afraid and frustrated. Sad that it might mean goodbye clear world forever, afraid that I can't return to my pre-dengue life anymore and frustrated that I'm the 1 in 100 (or is it 1000? whatever, point is, it is not common) people to get it. But seriously, there's no point dwelling in so much negativity and it's easier to accept and come to terms with it. Only time can tell now if I'll ever made 100% recovery from the maculopathy. Besides, I'm really grateful I did not lost my vision totally (which can also occur as part of the maculopathy complication!!) and that there are many more out there who are in even worse conditions. 

So, yeah, life is totally unpredictable. You never know what might happen tomorrow, hence even though you might had heard this cliche line a thousand times, but I cannot agree more that we should just live and treasure the present. Travel and see the world and do things that you have always wanted to do. Don't wait until it's too late! :)



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