Vacation Medication: A Note Of Caution - By Christine Talbot

Mrs W was enjoying a family holiday in Florida but developed a streaming nasal and sinus congestion with a persistent cough at the beginning of her last week.  All Covid tests were negative and she thought the heavy cold like symptoms had been caused by repeatedly going between efficient cold air conditioning into high outside temperatures.  Having forgotten her Day and Night Nurse remedy from the UK, Mrs W bought the equivalent cold/sinus congestion medication from an Amercian superstore.  She took two capsules of the day medication which dried up the runny nose and reduced her coughing.  Prior to bed Mrs W took one capsule of night decongestant from the blister pack of two.  She awoke three times during the night urgently requiring to pass urine. She felt very drugged and drowsy with a fuzzy head each time she got up.

 On Sunday, the day after purchase, Mrs W awoke with a bright red rash on her upper right quadrant of her body front and back, at this point her right arm was unaffected but she felt tired and unwell so stayed in bed.  During the course of the day the redness spread down the front and back of her torso and began to spread downwards to her right arm, her arm became hot, red, inflamed and painful to touch.  Immediately Mrs W took Flucloxacillin 500mgs, (doubling her first dose).  She continued to feel unwell on the Monday and Tuesday staying in bed and sleeping a lot.  Her right arm remained swollen, red and hot and the rash remained very red but did not spread further nor did she have the usual deep shooting pains. 

Wednesday was her daughter’s birthday, she was feeling a little better and was determined not to miss the celebrations.  The arm was still swollen and very red but the heat had reduced so she took regular Paracetamol and Ibuprofen and although not feeling particularly well she was able to go out.  As the week went on gradually the pain and swelling in the arm improved, the redness of the rash did not disappear but became less obvious. By the end of the antibiotics Mrs W was feeling a little better and ready to fly home. 

The onset of this possible drug related episode was different from previous onsets, signs and symptoms and  duration of attack.

Comments:

Mrs W was very badly affected by the Delta variant of Covid at the beginning of January 2021, she and her husband were completely bed bound for some time.  In April 2021, she had a severe episode of cellulitis she felt very ill with intense pains in the right upper limb, the arm swelled significantly and again she was bed bound. 

In November 2021 Mrs W was again hit badly with severe cellulitis in her  right arm experiencing the same very painful symptoms and complete inertia for days. 

Mrs W has previously experienced a localised rash reaction and redness affecting the arm when using some cleaning products and swelling of the hands on a walking holiday in the Lake District, she finds too much gardening can  exacerbate infection even though she is careful, so she is very sensitive to and very vulnerable to substances and change in circumstances.

Following Mrs W’s severe cellulitis attack in November 2021 I suggested she start taking a daily high strength probiotic, as I had watched a lecture on You Tube from an ICU Consultant in Oregon, extolling the virtues of probiotics in preventing sepsis.

It would appear the decongestant caused a need for the body to urgently detoxify by passing urine several times through the night, normally Mrs W might only go once.  The mere act of physically having to get up may have been the body’s response to preventing a full anaphylaxis collapse into unconsciousness.   It is speculative but the optimum level of probiotics already in Mrs W’s system may well have averted a nocturnal tragedy. 

‘In conclusion, the whole and sole purpose of writing this article is to highlight the importance of taking all your home medication when travelling abroad, particularly if your system is already compromised and vulnerable to change.

Christine Talbot. SRN. MLD. DLT.

 Editorial note: Mrs W lives with secondary Lymphoedema of the arm following breast cancer treatment.