Friday, 11 October 2019

Malaria Aftercare - How to Feel Better

Disclaimer: malaria is a shitty disease which kills thousands of people every week. This article treats malaria with a fair dose of humour, from the perspective of a well-fed, otherwise healthy individual with access to medical care. It's aimed at a similar audience and in no way seeks to detract from the seriousness of the disease or the loss of life it inflicts. Find out more at the Against Malaria Foundation.




Right, this is going to be a bit of a lengthy post.

Having just recovered from my second bout of malaria in four years, I was rather disappointed by the lack of self-help tips online. It seems there's top ten tips for anything from the common cold to erectile dysfunction, but when I looked for make-feel-good tips on malaria recovery, I only seemed to get advice on which medication to take and very basic dietary info.

Most people in the west - me having once been one of them - think that malaria is an emergency situation where you get rushed to the tropical disease unit of your nearest hospital and battle it out for your life.

Mostly, that isn't the case. In countries where malaria is a common disease, rather than a tropical one, treatment tends to be swift and calm. It's an outpatient condition most of the time. Provided you're otherwise fit and healthy, and you have access to medical care as soon as possible, you're likely to be over it in a week. It's not pleasant, but it's not the end of the world.

Prophylactics - duh!

Yeah... the reason I've had malaria twice is because I don't take prophylactics. The options in East Africa are pretty limited. We have a strain that's quinine resistant, so that doesn't help. The other options are Mefloquine (Lariam) which lists 'suicide' as a potential side effect and was recently banned by the British army for sending people slightly nuts. The other option is Doxycycline, a type of antibiotic which also helps protect against anthrax and black death, but has the unfortunate effect of making you super sensitive to the sun (not great on the equator) and can give you an acidy tummy. There's also Malarone, which usually has no side effects but is comparatively very expensive and recommended for short-term use. 

For that reason, most long-termers don't take anything, like the rest of the population. It's often more appealing to take a week out with malaria once every few years than to live with the daily side effects of prophylactics. It's a choice everyone makes for themselves.

Coartem

There are different strains of malaria. In my part of the world, East Africa, we get falciparum. It's a particularly nasty strain, considered the most deadly, but thankfully it's easy to cure. There's a Chinese herb called sweet mugwort (artemisia annua) which produces the key ingredient in Coartem, artemether. You take two doses for three days and it usually kills the parasites dead. It's also usually mixed up with antibiotics which help prevent complications, such as cerebral malaria.

There is still a persistent myth, even among travel nurses in the UK, that once you have malaria, you have it for life. I can't speak for other strains of the disease, but in the case of p. falciparum, that's no longer true. Once the Coartem's worked its magic, you're malaria free.

When I talk about my experience, I was treated with Coartem both times and it worked. I can't speak for other types of medication or their side effects. Please do share your experience if it differs.

My Experience

(Please also check this post as I've had it again since and there's some additional info on what happens when Coartem doesn't work.)

The first time I got malaria was in 2015. I'd been nursing a friend with typhoid in a clinic bathroom, holding back her hair and stroking her back as she emptied her will to live into the toilet. We'd just gone outside to wait for a taxi when I suddenly started to feel unwell.

"I'll be back in a moment," I said, then returned to the same bathroom and promptly vomited so hard I gave myself a nosebleed.

I knew that probably wasn't good, but I was determined to get my friend home safely. I went back out to wait with her, took her to the pharmacy, then went home to lie in my own bed, where I shivered and groaned all night. I assumed I had food poisoning, but another friend urged me to go to the clinic next day. I was fairly stunned to get the diagnosis of malaria. I'd lived in Rwanda for several years and never had it before. I knew it was a possibility, but it still surprised me.

I went to my private clinic at the time. They rehydrated me on a drip in a private room for FRW 50,000 ($54/£44), then sent me out onto the streets with a prescription for Coartem, which took four pharmacies to find and cost something like FRW 3,500 ($3.80/£2.95). I went home, took the drugs and felt a thousand times better within twenty-four hours.

This time, September 2019, the symptoms came on much slower, over a couple of days. It started with achy muscles, like the flu, a headache and a tight chest. I was actually golden monkey trekking at the time. I knew something wasn't right, but kept the aches at bay with soluble aspirin. It wasn't until I got home that I lay down for a nap and woke up with a raging fever, as high as 39.7 at one point.  

I was fairly sure it was malaria, but needed a diagnosis, so went to the local health clinic at Musanze, where I was at the time. It cost me FRW 1,000 to register ($1/£0.88) and about 2,000 ($2.15/£1.80) for the unbranded version of the medication. I was back at the B&B within an hour. 

The symptoms came on softly the second time. The first time I went from standing to on my knees in a matter of seconds, whereas this time it crept up on me slowly. However, the overall experience was a little more violent the second time around. I did a lot more vomiting, and at one point I was shivering so hard I convulsed, which was a bit scary. It didn't last long though, and once the meds kicked in it was a standard recovery.

What got me through, and what might help you...



Two's Company

Needless to say, recovery is a lot easier if you have someone there caring for you. I was lucky to have my parents and then my partner on hand to help me out. The first time around I was on my own. Even basic shit is exhausting and night shivers can be a little scary sometimes. Having someone just to throw a blanket over you and make sure you have enough water is a game changer, even if you need to slip your housekeeper a little extra to stick around.


Just be a little careful. Malaria isn't technically contagious, in that you can't pass it through touching someone, but if there are mosquitoes around, they could potentially bite you and then bite someone else. That's how you got it in the first place. So make sure your nets are down and you have a can of Doom to hand until the meds kick in and you're no longer a danger to yourself and to others.




Shivers and Shakes

It's hard to describe just how cold you feel when you have malaria. It's like your bones turn to ice and you can't get warm no matter what you do. The above gif is a very literal depiction of what your teeth do. It's comical, but also intensely unpleasant. At the same time, every muscle in your body tightens up as you shiver, which adds to the discomfort of already achy joints.

There isn't a whole lot you can do about this. It'll come in waves and you just have to ride it out. But make sure you have a couple of extra duvets handy, and someone to help you pile them on or keep a roll of them at the foot of the bed. A hot water bottle would also be sublime if you have access to such a thing, but again someone will need to bring it. When you've got the shivers, lifting the edge of your covers is like opening a door to the Arctic tundra.

Impossible as it seems, try hard to breathe through it and relax your muscles a little. If someone can lie on top of you or rub your shoulders and back, that can help a little. The more you tense, the more pain you'll feel later, and the more likely you are to convulse or panic. Hard as it is - deep breaths, try to relax, more blankets.




Sweats

The other end of the spectrum is uncontrollable sweating. Some people hallucinate during the fever cycle of malaria. I don't. I prefer it to the shivers and find the heat comforting. Everyone's different.

They say that sweating is a good thing - that it's the malaria coming out of you. A sign of recovery. The cycle of shivers and sweats does seem to go more towards the sweaty end as the meds kick in. The fever can be very high sometimes and your entire mattress can turn into one giant sponge.

Best advice: sleep on towels. If you wear night clothes, have a couple of pairs of fresh clothes next to the bed. When the sweats really kick in, you'll wake up with your clothes completely plastered to you. Everything will be wet, and you need to stay dry. If you lie in your sweat and it cools, the shivers will be worse when they come.

Fresh clothes to hand and absorbent towels to lie on, so you can wake up, strip, change, go straight back to sleep with as little fuss as possible. 

Cold compresses and water bottles are also welcome, especially if you've got someone who can go get them for you. I also find that being outdoors, just sitting on the porch, can help. I find fresh air very soothing, but make sure you can get wrapped up again if the chills strike.

Above all, make sure you have enough drinking water by your bedside. You're going to get thirsty a lot as you're sweating it all out. Staying hydrated is key. You need liquid to make new blood cells to replace all the ones that burst.



Vomiting

Keep a bucket by the side of the bed, obvs.

The first time I had malaria, I was only sick once, at the moment it broke. This time, I was sick almost on a 12-hourly basis. I had absolutely nothing in me, but, like clockwork, I'd start retching until it hurt. I swear, chewing gum I swallowed when I was twelve came back up. 

It's hard to stay calm when you're going full-Regan, but it's just part of the cycle of pain and it will pass.

I think the vomity part of this varies on a case-by-case basis. What I noticed was that the moment it finished, I was able to drink water or milk and keep it down. It wasn't continuous nausea. It usually came after a strong dose of shivers. After the retching, I felt much better. The trick was timing my attempts to eat and drink around when I reckoned the next vomit sesh was likely to happen.

You're supposed to take Coartem with milk because it's rough on your stomach, but I would suggest sipping milk whenever you can, just to put a little lining on your stomach so you have something to bring back up. Avoid undiluted fruit juice as that stuff gets acidy. 

Also, there's no shame in being sick out of your nose... I had no idea that was even a thing.




Music

You're going to be in a huge amount of discomfort. It's been clinically proven that music can help relieve both acute and chronic pain. Google music reduces pain for more on that.

I usually sleep in silence, but when I'm really sick - and malaria certainly counts as that - I play music on my phone. Whereas this is extremely soothing for me, and helps me get off to nod, your choice of music might be painful for others. This time around, I had Joshua Kadison's Jessie on repeat for six hours. It was the first tape I ever bought, and I still find the piano very soothing.

Really, whatever it takes.

Nothing that requires concentration. Audiobooks are out. Either you'll tire yourself trying to keep track of what's going on or you'll fall asleep and wake up in time for the final credits. Choose something that doesn't take any thinking about.



Rocking

Curl yourself up slightly, or stretch out - depending on what stage of 'ouch, my muscles fucking hurt' you're at - and get a little rock on. A gentle back and forth. A little movement helps take your mind off the aches. Combine that with...


Humming

Humming, tutting, shushing, tongue clicking - any repetitive noise can be really cathartic.

Yes, lying there rocking and humming to yourself does look mildly psycho, but it can really help. Besides, who's watching?

Whilst the rocking helps sooth your muscles, the humming helps distract the mind and regulate breathing. You might not want to do it all the time, but when the pain's gnawing at you, it can provide some respite.



Sleep

Try to remain unconscious as much as possible without slipping into a coma.


*

Once you're over the worst...

Recovery from malaria is usually pretty swift once you get the drugs in your system. Coartem is a three-day course. The critters are dead by the end of it, but it can take one to two weeks to regain your strength. Remember, your blood cells just exploded - that's a pretty big deal. 

As well as drinking plenty of fluids and getting lots of sleep, here's some other tips.





Licking

One of the weirdest aspects of malaria is the effect it has on your appetite.

I've noticed that one of the really early symptoms of malaria for me is an extreme appetite shift. I'll go from feeling normal to starving hungry in a split second, but one mouthful of food has me full again.

Once it breaks, and you're in the sweats and shivers, you don't want to eat anything. The saying in England is 'starve a fever, feed a cold.' It's usually true that when you have a fever, your body only wants liquids.

Then the weirdness kicks in. As you start to recover, it's common to feel really hungry but be completely unable to eat. Not because you worry you'll throw up - it's more psychological. You're hungry, you want to eat, but you're incapable of putting anything in your mouth and chewing.

It's like those stage show hypnotists where they get people to put their hands together and when they wake up, they can't separate their hands. It seems like the easiest thing in the world to do - just pull them apart - but they can't.

I remember the first time, I thought it was a really weird insight into the mind of an anorexic. It should be the easiest thing in the world: open mouth, insert food, close mouth, swallow. But you just end up staring at the food.

It passes in a few days, but starting to eat solid food again can be a challenge.

I find that licking helps.

You can't put food in your mouth - but you can lick it.

A little bit of porridge, peanut butter, anything that sticks to the back of a spoon. It's not exactly eating, but it's conveying nutrients to your system. Take that, psychology!




Gentle Touches

This might be one your housekeeper isn't willing to help you out with - but once the meds have worked their magic, a little bit of human touch is extremely nice. You're likely to be sore all over, and pain's greatest antidote is a little bit of pleasure. Kisses, strokes and anything that doesn't require too much movement. You're not going to be feeling sexy after all you've been through, but a little gentle touch can help you re-energise and relax. It's also a sign you're on the road to recovery.




Shower

The first shower after sickness is a glorious thing. It's a ritual rite of passage where you are resurrected from the land of the dead to the land of the living. 

Luxuriate. Get it to the right temperature, use every nice-smelling product on the shelf, and soak the malaria out of yourself. Water is soothing. Just maybe avoid baths in case you fall asleep, slip under the water and drown. Standing up's a pain, but it keeps you safe. Or take a plastic chair in there with you.

If someone can change the bedding whilst you're in there, that's a major bonus. 

For me, that's the major sign I'm on the mend - clean body, clean sheets. 

All fresh and nice.




Food

Finally, getting back on the eating train. 

Think of this as your new beginning - there's nothing left inside you, you've just had the most extreme detox of your life, so treat your body as a temple from now on.

If you've ever thought about giving up alcohol, caffeine or smoking, now's as good a time as any. You've already had a week's head start. 

Fruit is a great first food. A lot of people say you should take warm things when you're ill, but when I'm sick I crave cold things. I froze pineapple chunks and put them in a smoothie blender with other things like bananas, tree tomatoes (tamarillos) and passion fruit - whatever's local and in season.

Mum also made me fluffy scrambled eggs, which is something she always made when I was sick as a child. I find it really comforting and easy to keep down. Plus, protein is important for malaria recovery. 

As I mentioned, people often find it difficult to start eating solids again, so build up slowly. Let other people order something and pick what you fancy from their plate. You'll feel full really fast, and things you thought you wanted to eat will arrive and you'll change your mind.

It's probably not recommended, but I found myself craving Fanta Citron (fizzy lemon). Full of sugar and carbonated water, and ice-cold. I only had a couple of sips, but it made my whole world brighter. There really are no rules on this, so just go slow. 

Once you can eat chocolate again, you're cured.

*

So, those are my top tips for malaria recovery. Obviously, keep an eye on your condition and if you're really worried, get back to the doctor. In severe cases it can take more than one course of Coartem, but you should feel worlds better within three days of the meds, and back on your feet within a week.

It's been eleven days since my malaria first broke and I'm feeling totally fine again and about to hop a bus up country tomorrow. Those first few days will feel like a lifetime, but take the meds, get plenty of fluids and sleep, and you'll be right.  

[UPDATE: also see my post on What Does Malaria Feel Like?]

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