August 16, 2008

La Gringa went to the emergency room

This is an article I started long ago. It seemed like old news but since people are often interested in medical care in Honduras, I thought it might be useful.

My symptoms first began with some strange unexplained and I thought unrelated pains. First I began getting little pinprick pains in my scalp that caused me to go "OUCH!". It was so strange that I finally asked El Jefe to check my head to see if there was something there biting me! Then I began to have excruciating sharp pains in my ear drum which would cause me to go, "&*#@!" (censored). My ear felt perfectly normal most of the time, but about every hour, I would receive a horrifyingly sharp, stabbing pain or two or three in my eardrum.

On Friday (June, the 13th, ironically), I felt weak and dizzy and had other flu-like symptoms. Then I started feeling generally bad. The rash began with a few red dots on my forehead along my hairline which I originally thought was just a heat rash. I was really wondering what was happening to me with all these strange seemingly unrelated problems.

After the blisters started forming on Saturday and after much internet research of rashes, I was able to determine without a doubt in my mind that I had shingles. I had the unmistakable rash, plus the other symptoms which I originally thought were unrelated.

As soon as I figured out what it was and how important early treatment is, we rushed to the best hospital in La Ceiba on Sunday morning. On the way, I asked El Jefe how I could handle it if the doctor misdiagnosed the problem − without insulting the doctor. Oh, I know this sounds arrogant of me, but I KNEW that I wasn't wrong that I had shingles. I'll admit that I'm very afraid of the doctors. I've heard too many stories.

The doctor walked into the emergency room, I pointed to my forehead and he said, "Alergia." (allergy) In my distress, forgetting what El Jefe had told me, I said, "No, uh, ....." and the doctor interrupted to guess, "Varicella" (Chicken pox), and again, I said, "No, uh, ....". He then said, "Herpes Zoster!" and I exclaimed with relief, "Si!".

He was very nice and very sympathetic about the pain, stressing to El Jefe what a painful disease this is. "Duele. DUUUU-e-le." he repeated several times. I think doctors do that especially here in Honduras because sometimes the husbands are not very sympathetic toward the women and expect them to continue cooking and cleaning no matter their problem is. I, of course, have a wonderful guy who is always understanding, sympathetic, and who took good care of me throughout the duration. Lucky me.

El Jefe was very impressed (with me) that the doctor repeated almost everything I had told him from my internet research. The doctor even suggested that I be hospitalized which I thought was way overkill. I said no to that.

I was immensely relieved that he prescribed one of the three recommended drugs, though it happens to be the older drug and the two newer ones are said to work a little faster/better. I mentioned that my research reported that but he said that we would never find those two drugs in La Ceiba.

He spent some time writing the prescriptions and occasionally gazed up into the air as if thinking, and then would write another prescription down. I ended up with five prescriptions plus an injection − I don't think it is possible to leave a hospital without getting an injection. Everyone loves injections and even patients feel cheated if they don't get one. I wondered if that was overkill, too, and whether he was over-prescribing in order to jack up the bill for the gringa. (Prescriptions were filled by the hospital without asking us if we wanted to take them elsewhere.) Maybe, maybe not, but it seemed strange to me to get three different NSAIDs (non-steroidal anti-inflammatory drugs) and Claratin (an allergy drug).

I should back up and say that he mentioned to El Jefe (not me) that the required antiviral drug was very expensive, as if to ask whether we wanted it or not. El Jefe was quick to say that "Her health is more important than money. Whatever it costs, it costs." The doctor nodded and agreed and continued to write the other prescriptions.

One thing that the doctor did not mention is that while shingles itself is not contagious, someone with shingles CAN give chicken pox to anyone who hasn't had it. While we were waiting to check out, the nurse told us to wait in a little room to the side. At first I thought it was because I was contagious and I was impressed that they even considered it. But no. Two young school girls came in there to wait. I turned to El Jefe and said, "I shouldn't be around them!" They soon left the room, but when a mother came in and sat next to me holding her newborn baby, I couldn't stand it anymore and went outside to wait. Jeesh!

It turned out that the hospital pharmacy was out of the antiviral drug − the most important one. We took the prescription to two other pharmacies before we found it. I was in a panic, fearing that the drug would not be available in La Ceiba, knowing that even waiting until Monday would not be a good thing.

While I had written down the names of the recommended drugs, I hadn't written the dosages. After getting home, I checked the prescribed dosages on the internet and was extremely disillusioned to find that the doctor had given the wrong dosage − approximately 1/4 of what the dosage should be according to the drug manufacturer as well as every site I found on the internet. Since early treatment − with the proper high dosage − is so important, I felt like the doctor was really irresponsible not to look up the recommended dosage.

El Jefe asked if we should go back to the doctor, but I said, "No way! You know he would just be insulted and probably angry if I told him it was the wrong dosage." Luckily, this is Honduras and a doctor's prescription is not required for most drugs, so El Jefe took my list of drugs and found that one of the other drugs was readily available. It wasn't the proper dosage for shingles so I had to take two pills at a time, but it was better than having to take four pills five times a day with the original drug that the doctor prescribed.

Though the rash often occurs on the upper body, mine was on the right side of my forehead and scalp. Both were covered with huge blisters, giving my head a misshapen gargoyle-like look. It spread to my right eye which swelled completely shut. One blister and then several appeared right on the edge of my upper eyelid, poking me in the eye. Eventually the swelling in my forehead, right eye, and the bridge of my nose got so big that the swelling spread to my other eye. Luckily that one never swelled completely shut, though it was a real effort to hold it open enough to be able to function.

I could barely wash my face because of the pain and could not even lightly brush my hair on the left side due to the pain. I couldn't even touch my hair. A cough or sneeze resulted in electrifying pain in my forehead and scalp, as if someone pounded in 20 needles at the same time. If a breeze caused a single hair to brush across my forehead, I would cringe with pain. Sometimes I would be right in the middle of a sentence and a terrible pain would cause me to call out, "Oh, *&$%!!"

While the pain decreased, it lasted for more than a month. Even now, two months later, my forehead is somewhat tender and has a strange paralyzed feeling. The headaches were almost constant for a couple of weeks after the rash. I was only able to start wearing my contact lenses after about two weeks and then only for part of the day. The forehead skin looked and felt as if it was burned.

The redness is gone now and I'm hoping that the dark scars will dissipate. I'm putting Vitamin E on my forehead as recommended by one of my readers who is a nurse. Thankfully, the blogicito seems to have a lot of doctor and nurse readers and I've appreciated their advice. (Don't worry, no lawsuits forthcoming − this is Honduras!)

Just for comparison, the emergency room visit cost L.400 (US $21), which is extra for a weekend visit. Of course, I guess you get what you pay for since I diagnosed myself and had to correct the drug dosage. The cost of giving the shot was L.20 (US $1). The name brand antiviral drugs were about $130, hugely expensive for Honduras. Lyrica, the pain medication that I took for about three weeks was not quite as expensive, running about $32 per week. I'm taking name brand medications as the generics sold in Honduras can be iffy.

Overall, I was very impressed with the quality of medical information on the internet and was not impressed with the medical care that I received in La Ceiba. I believe that if I had not educated myself, I would have been treated for allergies for a week or so and by then it would have been too late for the shingles treatment.

For more about shingles, see "Shingles - Revenge of the chicken pox."

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