Q. Dengue Hemorrhagic Fever

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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

A. Dear Dan,
I am sorry to hear about your travails. I can only imagine how painful your experience was. The fact that you continue to have multiple symptoms long after a bout of hemorrhagic dengue fever is indeed a puzzle. Most recover uneventfully within several weeks. As you probably know, immunity is not granted as a result of one or more infections. An infection can increase the chance of acquiring another contagion. The local infectious disease specialists I spoke with claim that, in the practical world, all bets are off. What the textbooks claim is simply a conceptual dogma.  Therefore, prevention is the key to good health.

Since a definitive answer to your current dilemma isn’t possible, we need to come up with an educated guess that would work for you. There are anecdotal accounts of folks developing fibromyalgia like complex after a bout of dengue fever. Others have described the onset of diffuse arthritis. Depending on your orientation, you may wish to seek help from a very experienced homeopath, an acupuncturist or an Ayurvedic practitioner. A main stream approach would be to get into a regular exercise program (a sine qua non), consider brief pharmacotherapy, reframe your current illness by means of cognitive based therapy and or some form of a spiritual practice. An ancient Chinese proverb states that water cannot be cut with a knife. Human beings cannot be divided into body parts or for that matter, the distinction between the mind and the body is arbitrary. A holistic approach using one or more of the above mentioned modalities will offer you some amount of relief.

Regarding your labile blood pressure readings, we can be more specific and hopefully more helpful. The best way to obtain an accurate reading is to get a 24 hour monitor. A single reading is inadequate. A drop in blood pressure while one is asleep (if you are not dreaming) is a good sign while its absence betrays a pathological state. The so called “white coat syndrome” (high readings in a setting of doctor’s office or hospital) may not be so benign after all. There are many people who have a “reactive vascular pattern”. That is, ones reaction to an ordinary stimulus is over exaggerated. This may account for the majority of people who have high blood pressure. Just look at the word hypertension; hyper and tense. Describes the phenomenon quite well, doesn’t it? There is a significant genetic predisposition to high blood pressure (I will discuss an emerging field of epigenetics later where we can alter the gene expression through natural means). Many are also salt sensitive. It is very important to mention that high blood pressure needs to be controlled. However, before jumping into pill taking, you have many reasonable alternatives. If your blood pressure is excessively high (say 170 over 120) chances are that you will need to initiate your treatment with pharmacology since the more natural approaches won’t be as effective. For labile hypertension aka pre-hypertension (as is yours) here are some means for your consideration. The fact that your diastolic number (the bottom number of your blood pressure reading) is disproportionately high suggests a “tense” response. Therefore, moderate exercise, reduced salt and caffeine use, relaxation techniques, massage, reduced alcohol consumption (if you drink) should work. There are many nutritional supplements and mechanical gadgets available to lower your blood pressure but I personally don’t think these are necessary if you are diligent with the former approach. Incidentally, there is a myth among Western medicine practitioners that ones blood pressure naturally rises as one gets older. This may be so in cultures where old people get fat and lazy. In cultures where older folks stop working, approach their waning years with calm and ease, continue to exercise moderately (such as walking) and maintain judicious diets, their blood pressure actually drops after retirement. So I would suggest that you use your “high blood pressure” as a message from your body to get more introspective and by using the innate wisdom of your body and mind, turn things around for a healthier and happier life.

Dr. Philip Bhark M.D., FACC