Parliamentary Election - 2015 & Post Viral Fatigue Syndrome (PVFS) in Dengue Infection

As election results pour in, I find myself at home, halfheartedly searching for rental properties. Lately, I've been feeling under the weather - lacking motivation, constantly tired, and uncharacteristically lazy. It's been a while since I've updated my blog or hit the gym. This morning, while pondering whether my bout with dengue fever last year might be connected to my current state, I found myself googling the aftereffects of dengue.

Photo credits: gettyimages, Buddihika Weerasinghe

It's been over a year since my dengue ordeal, which I dramatically recounted in my earlier post, "Everything is a miracle." In the immediate aftermath of the fever, I might have felt as if life itself was miraculous, but I certainly don't feel that way now. While I long to recapture that sense of wonder and appreciate life's joys, I find myself struggling. This brings me to the crux of what I want to share today - my observations and experiences with the lingering effects of dengue.

After extensive online research, I've tentatively self-diagnosed with Post Viral Fatigue Syndrome (PVFS). While my symptoms aren't severe enough to completely disrupt my daily activities, they've noticeably impacted my ability to function at my pre-dengue levels - physically, mentally, and socially. The symptoms I've identified include:

• Unrefreshing sleep
• Sore throat
• Unfamiliar types of headaches
• Post-exertion malaise
• Cognitive difficulties (especially with memory and attention)
• Widespread muscle and joint pain
• Mental and physical exhaustion
• Mild stress or depression

Given that these symptoms are manageable and don't severely impair my day-to-day functioning, I prefer to label this as Post Viral Depression rather than Chronic Fatigue Syndrome (CFS). From my research, the exact cause remains unknown, but several studies suggest that viral infections like dengue can trigger the condition. Other potential causes include certain bacteria, immune system issues, hormonal imbalances, psychiatric problems, genetic predisposition, and traumatic events.

The most challenging aspect, in my experience, is the vicious cycle it creates. The associated anxiety and mood disorders make me feel ill, and feeling ill, in turn, increases my stress. Interestingly, some of my colleagues who also contracted dengue don't report experiencing significant fatigue symptoms beyond the acute phase of infection and hospitalization.

A study conducted by the Department of Medicine at Yong Loo Lin School of Medicine, National University Singapore in February 2008 examined the incidence and factors associated with post-dengue fatigue. Their findings, based on a two-month follow-up of serologically confirmed dengue patients, revealed that increased age, female sex, the presence of chills, and the absence of rashes were significantly associated with the development of post-dengue fatigue.

According to www.epid.gov.lk, during the last 8 months of 2015, 18,830 suspected dengue cases were reported in Sri Lanka, with nearly 50% occurring in the Western province. The fourth week of 2015 saw the highest number of cases - coinciding with my own infection. Many of my colleagues from the Gampaha district have experienced dengue at some point in their lives.

Photo Credit : ipsnews.net

Despite efforts by Sri Lanka's Health Ministry to prevent dengue and raise public awareness through websites like www.dengue.lk and www.dengue.health.gov.lk, and funding from the European Community's Seventh Framework Programme (www.denguetools.net), we seem to lack the necessary level of awareness. The prevention methods employed in Sri Lanka appear ineffective and unreliable. Street posters and hospital handouts are insufficient to combat dengue effectively.

The government should implement and strictly enforce policies on housing and property maintenance in polluted and densely populated areas. Our drainage system, essential for flood prevention in urban areas, is nearly a century old and poorly maintained. Local businesses should be responsible for managing local drainage networks, while individual property owners should maintain drainage systems on their properties.

If we don't elect a government that rigorously enforces these measures, instead of merely discussing price reductions on goods or playing the race/ethnic card to win elections, we risk becoming a nation of fools.

In conclusion, while the effects of dengue can be long-lasting and challenging, it's crucial that we as individuals and as a society take proactive steps to combat this disease. Only through increased awareness, improved infrastructure, and responsible governance can we hope to reduce the impact of dengue on our lives and our nation.

References

Bennett, A., Fagioli, L., Komaroff, A., & Raoult, D. (1994). Persistent Infection with Bartonella (Rochalimaea) henselae or Afipia felis Is Unlikely to Be a Cause of Chronic Fatigue Syndrome.Clinical Infectious Diseases, 19(4), 804-805. doi:10.1093/clinids/19.4.804

Epid.gov.lk,. (2015). Dengue update. Retrieved 18 August 2015, from http://www.epid.gov.lk/web/index.php?option=com_content&view=article&id=171:dengue-update&catid=51:message-for-public&Itemid=487&lang=en

Forums.prohealth.com,. (2015). Postinfectious fatigue syndrome in dengue infection | ProHealth Fibromyalgia, ME/CFS and Lyme Disease Forums. Retrieved 18 August 2015, from http://forums.prohealth.com/forums/index.php?threads/postinfectious-fatigue-syndrome-in-dengue-infection.193179/

ME Association,. (2008). Post-infectious fatigue syndrome in dengue infection (revised 21/03/08). Retrieved 18 August 2015, from http://www.meassociation.org.uk/2008/03/post-infectious-fatigue-syndrome-in-dengue-infection/

MedicineNet,. (2015). Patient Comments: Dengue Fever - Describe Your Experience - Viewers Share Their Medical Experiences - MedicineNet. Retrieved 18 August 2015, from http://www.medicinenet.com/dengue_fever/patient-comments-159.htm

Mørch, K., Hanevik, K., Rivenes, A., Bødtker, J., Næss, H., & Stubhaug, B. et al. (2013). Chronic fatigue syndrome 5 years after giardiasis: differential diagnoses, characteristics and natural course.BMC Gastroenterol, 13(1), 28. doi:10.1186/1471-230x-13-28

Seet, R., Quek, A., & Lim, E. (2007). Post-infectious fatigue syndrome in dengue infection. Journal Of Clinical Virology, 38(1), 1-6. doi:10.1016/j.jcv.2006.10.011

Everything is a miracle

Last Wednesday morning, I had grand plans. I wanted to arrive at work early, complete my tasks efficiently, and return home with time to organize our new rented house. The recent move had left everything in disarray, and I felt compelled to restore order to my slightly altered life. Lately, I'd been feeling physically drained, lacking motivation to tackle these necessary changes. I wondered if the rainy weather or the lingering knee injury might be contributing to my lethargy.

As I began my workday, an intense pain gripped my body, accompanied by chills far beyond the usual effects of office air conditioning.

How illness makes me see the world

I promptly informed my colleagues, partially completed my morning tasks, had breakfast at the office, and decided to head home on sick leave, my mind racing with a million thoughts. Usually, I avoid doctors - I can't even recall my last visit. Assuming I'd caught the viral fever making rounds among my friends, I figured a week of rest would suffice, regardless of medication. My feverish mind could only focus on how to endure the coming week and return to normalcy. Despite the fever's fog and discomfort, I hopped on my bike, intent on getting home to sleep it off.

Now, two weeks later, having survived this dengue fever ordeal, I realize it's nothing short of miraculous that I'm alive today. The odds were stacked against me at every turn. Let's break down the probability of my survival:

1. Deciding to go home instead of staying at the office - 50%
2. Opting to seek medication rather than just sleeping it off - 50%
3. Choosing to visit a doctor instead of just buying pharmacy medicine - 50%
4. Finding a competent doctor who suspected dengue and ordered appropriate tests - 50%
5. Actually getting the blood test after two days (as someone who never takes blood tests and didn't suspect dengue) - Should be 1%, but let's say 50%
6. Returning to the doctor, discovering it was dengue with low platelet count, and getting hospitalized - Again, should be less than 1%, but we'll say 50%
7. Having sufficient platelet count for the hospital to administer saline and increase platelet levels - 50%

So, that's 50% * 50% * 50% * 50% * 50% * 50% * 50% = 1/128, less than one percent chance of survival.

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Even if we exclude the first step, which might seem less critical, we're still looking at roughly a 1/64 chance of survival. It's mind-boggling when you consider all the situations where we could have died but didn't - wars, diseases, accidents, natural disasters. Is there some internal mechanism in our brains guiding us towards safer choices? It's hard to comprehend.

“There are only two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle.” 

― Albert Einstein

During my recovery, sleep was my primary activity. When sleep eluded me, I found myself pondering life's intricacies, leading to some valuable insights. If you want to be happy, please consider the following:

1. Eliminate mosquitoes on sight. Invest in effective mosquito-killing tools.
2. Take action against those who ignore the mosquito problem.
3. Drink at least 100 ml of water or other liquids hourly.
4. Consume plenty of fruits and maintain a healthy diet.
5. Get ample rest and sleep.
6. Slow down when needed. (I often rush without purpose. Now I remind myself to pace myself and rest when necessary.)
7. Six hours of focused, smart work outperforms ten hours of distracted effort.
8. Exercise and meditate regularly.
9. Constantly revisit life's important lessons.
10. Spend time alone contemplating life's mysteries and seeking solutions.

“There is more to life than simply increasing its speed.” 

― Mahatma Gandhi

I hope this post, my attempt to productively use time on my new tablet, proves useful or interesting to you. Thank you sincerely for reading my musings. Until next time!