Allergy, Antihistamines,, Antibiotics
Replies: 5 - Last Post: Nov 11, 2012 6:56 AM Last Post By: nrclibn
Nov 3, 2012 7:21 AM
Allergy, Antihistamines,, AntibioticsI've seen a doctor in Lao and one in Thailand (today), and I'm pretty confident with both doctors to a point but I wish I could pick up the phone and chat to a European doctor!
Long, would love some input.
The full picture: (terse in places - typing on a smartphone.)
I was in Laos for just under 4 weeks. About 2 weeks ago I started developing a rash on the skin of my arms and back, initially behind the armpit, and shortly thereafter the back of my waist where the bumbag strap sits.
It started to cover my back. Red raised area of skin, no fluid-filled pustules. Itchy as hell. Tried antifungal cream, no effect.
I did really suffer from the heat initially, thought it was probably a heat rash, but Googled it, worried it was scabies...i found a lovely English-speaking phamacist who thought it was likely heat rash or perhaps an allergy. Sold me some oral antihistamines.
These helped with the itching but not the rash. Rash spread down my buttocks, then legs (only the back).
I've been trying not to scratch (not always successful), wary of secondary infection.
Oh, ankles often slightly swollen, again decided it was the heat (I am female in early middle-age, pre-menopause)
2 nights ago, my right leg swelled alarmingly. I went to the Savanakhet hospital, glad I was also so near to Thailand.in case.
Very little English but the doctor and I were both careful to communicate. He didn't examine me much but gave me 2 antihistamines (Fexet and Chlorpheniramine) for a 2.5 day course, told me to sleep with the leg elevated.
Somewhat reassurred, the drugs did help.. Leg still swells during the course of the day, but itching diminished and rash on torso also improved, legs not much yet).
As my Lao visa is nearly expired I decided to cross into Thailand and come to the Mukdahan International Hospital (privaately run). I thought I'd rather know there wasn't also a thrombosis or something else. (hypochondria? Never been seriuosly ill so don't know when to panic!)
Glad I did come as the bill in Thailand was only 20 quid including a white blood cell count and urine bacterial(?) test,
(10 GBP was vastly over-priced hospital pharmacy - guess it's a good money-maker.) BTW I am of course insured.
So, Thai doctor, much better English:
Tests indicate no systemic infection.
Asked if I had scratched a lot; obviously no blood infection.so far.
Gave me a course of Dicloxacillin 500mg and some steroid cream.
Said she'd prefer to see me again in a few days, but if I felt I didn't need to, up to me.
Now I avoid steroids and antibiotics wherever possible - but I think this is the time to use both?
Particularly the antibiotics, just in case something is infecting the skin due to scratching?
Also I asked her about taking one of the antihistamines for the rest of my trip - planned 1 more month before home - and she recommended the chlorpheniramine 4mg (30p/100 at local pharmacy).
Is that a reasonable course of action?
I don't know if it's heat, food allergy, contact dermatitis, bed bug allergy ( yup :-( Vientiane) so don't know what to avoid. This is my first brush with such a problem. At home I could try eliminating things more easily.
I eat Thai food in the UK ocassionally. Hope I haven't become sensitised to fish sauce :-(
I am washing my own clothes in Thai washing powder, rinsing well.
Was sleeping in a permethrin-treated silk sleeping bag liner since the bedbugs but have now stopped in case it was that - I sleep on my back, rash back only).
If you've read this far, THANKS!
Thoughts/dialogue welcome please.
I am planning on taking the antibiotics, having realised while typing this that it may knock out some bacteria lurking in my skin, so arrestiing future problems with that bacteria.
Nov 3, 2012 11:25 AM
1At some point you have to go with a doctor's advice. You can always contact your nearest embassy/consulate in Thailand and ask if they can recommend someone near to your current location. To be honest, a European doctor (as in based in Europe) is not always going to be the best choice when it comes to tropical diseases or local outbreaks. And trying to display a rash to someone over videoconferencing or by sending pictures doesn't always work too well, either.
So, if you're not going to go home...
1) Go back to the Thai doctor after a few days of using the antibiotic and steroid cream. Use both, as prescribed, instead of ignoring parts of her directions. Wash your hands after applying the cream and you won't unwittingly eat the steroid. Be honest when you see the doctor again, especially if you choose not to use the steroid.
2) If you're truly concerned about food allergies, spend a few days eating nothing but boiled white rice with a little salt, boiled eggs, boiled water, coconut water with nothing added, and bananas. Prepare it all yourself, so you know exactly what the ingredients are. See if that makes a difference. (If you're not willing to go the bland food/elimination/do-it-yourself route, you don't really think you have a food allergy.)
3) The steroid cream and maybe the antihistamine is/are absolutely key in stopping the itch-scratch-itch cycle. So again, use the drugs as prescribed. (I am wondering if you are mistaking hydrocortisone for a much stronger and more dangerous steroidal medication.)
Best of luck...
Nov 3, 2012 7:22 PM
Thanks for the advice, I hear you and you are absolutely right :-)
I was being a bit resistant, but typing my post above I realised this is not the time and situation to be so. I really appreciate the quality of both the doctors I saw, and I realised that the antibiotics are essential because of the scratching/infection issue.
I am using the cream and the antibiotics, I agree that the doctor's advice is worth following.
With regard to the cortisone -I won't be using it long-term, so long-term effects don't apply.
Elimination diet; why not try it? Your suggestion is easy enough to follow when I don't have access to a kitchen. I now have some phrase and dictionary apps to help me.
Thanks for being the serious voice of reason. I needed it.
Nov 5, 2012 8:15 PM
3I can only back-up what was said before (even though you sound convinced) - go with the Thai doctor (or some other doctor there recommended to you). I've lived in Asia for ages, and have much more faith in the doctors here in most cases - they generally see a lot of patients (and have a more diverse range of experience), and they know best what problems are seen in the area. They will also have a different approach to treatment because of this (i.e., be more concerned about secondary infections). If the communication problem is bothering you, you could seek out a western doctor practicing there or if you get really concerned go down to Malaysia / Singapore for treatment.
Nov 11, 2012 4:23 AM
Absolutely! Thanks though.
I followed the doctor's regime of antibiotics and steroid cream; it does seem to have "fixed" the problems.
I agree about the local doctor having more clue about local problems; and Thai doctors have a pretty good reputation overall, it seems.
I've also been eating fruit (that I'm used to at home) and rice for a few days, roughly following nrclibn's suggestion.
End of the day I don't know what caused the rash. That it was on my back only makes me wonder if it was something on/in a bed-sheet...who knows. I'm not generally an allergic person.
Nov 11, 2012 6:56 AM
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