Q. Dengue Hemorrhagic Fever

I have two questions for Dr. Bhark:
    1.    In October of 2010 I was diagnosed with Dengue Hemorrhagic Fever.  It was bad enough that I chose to spend close to 10 days in a local hospital.  After about two weeks, my doctors declared me free of the virus based on blood tests. However, the affects of Dengue were anything but gone.  I suffered from severe fatigue for the next full month.  I was working at the time, and it was one of the most difficult things I had to do just dragging myself to work every day.  After about six weeks the fatigue became less severe, but I just did not feel “right.”  I also lost about five kilos of weight over the next few months, and in April 2011 I decided to quit work due to constant fatigue.  It’s now February 2012.  I started feeling better near the end of 2011 and joined a health club.  I’ve been working out consistently, have gained my lost weight back, and I’m planning to go back to work after Songkran.  It’s been very difficult to get my family and friends to understand how tired and fatigued I was for over a year – but it was very real, and very debilitating – it wasn’t just “in my head.”  Can Dengue Hemorrhagic Fever have such a long term effect on an individual?
    2.    I’ve noticed that my blood pressure fluctuates rather extremely.  One day I might visit the doctor and my BP is 115/70.  The next visit it may be normal.  The next visit it may be 160/90.  But every time I visit a doctor and I get a high reading, they immediately recommend high blood pressure medicine.  I think that if I averaged my BP over a period of a year, the “average” would be in the normal range.  But I have a very wide range of BP.  What could cause such a wide range of BP readings?

Dan

Q. Working Out

I would like to comment this month on working out. I hope everyone here in Chiang Mai is delighting in our perfect weather. It is easy to be outdoors, swooned by the song birds, dazed by the brilliant flower blossoms and comforted by the gentle winds and the warm sun. No need to get out early in the morning before the furnace like heat causes a melt down nor do we have to wait until sunset to exercise, exposing us to the hungry mosquitoes during their feeding frenzy or the dogs who are fully alert by now in protecting their turf. So what is the “best” exercise? This question gets asked often by all comers.

Q. Medications

A reader asked me how to obtain Lipitor, a cholesterol lowering drug.

I have only had limited experience with local pharmacists and therefore will make the following suggestions with a caveat.

Yes, Lipitor is readily available as are many brand name medicines. However, prices vary and therefor you need to do due diligence and find a pharmacy you feel comfortable with.

Drugs manufactured in Western countries or elsewhere but under the guidance of the parent company need to meet very high standards of production. Unfortunately, this is not true for drugs coming from some of our neighboring countries. I believe that generic Thai pharmaceuticals are fine, especially if the cost of medication is a consideration. So ask your pharmacist where the drug is manufactured and by whom before making a decision. You will also notice that some brand name drugs are cheaper here than back in the West. The simple reason is that the parent company has subsidiaries in this part of the world. Cheaper brand name drug doesn’t mean that it is fake, however, fake drugs are common, especially on the Web. Fake drugs are not only ineffective but can be quite dangerous. They are usually made with highly toxic chemicals. They can look uncannily real. Therefore it is important to work with a pharmacist whom you can trust. Finally, about 80% of generic drugs are just as effective as the brand name. Therefore, when taking a generic medication, make sure that it is doing whatever it was designed to do. So for example, if you were taking a brand name drug to lower your cholesterol and then switch to a generic med and a follow up cholesterol check reveals a markedly elevated blood level for no apparent reason, it would be possible that the generic med is less efficacious. For this particular article, I will not comment on other means of lowering your cholesterol.

All the Best, Philip Bhark, M.D., FACC

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Q. Drug Side-Effects?

Dear Dr Bhark,

Following on from your very interesting talk last Saturday (@ChiangMaiExpats), may I ask you a question. 

Our daughter aged 45, suffered an unexpected ‘cardiac event’ about 18 months ago, following a period of overwork and chronic stress.   

Thankfully she fully recovered after treatment at a leading cardiac hospital in the UK.    Her own GP put her on Simvastatin 40gms, Ramipril 10gms and Congescor 2.5mgs.  Since then there has been a radical and negative change in her personality.  

Have you experienced similar personality changes with patients on statins?