jeebusjones

Well the headaches have subsided, but over the last two days I've developed strange back and neck pains, of the sort I've never had before. Hopefully it's due to stress, but obviously anything involving the CNS is worrisome.

Yesterday I met with another doctor at Tan Tong Seng Hospital, and she claimed to be Singapore's foremost rabies expert. She agreed that there was a certain risk of my having contracted rabies, but her personal opinion was that I hadn't. She suggested that all of the symptoms I've been experiencing are likely due to other causes, particularly since they've been going on for so long now. Had they been due to rabies, she said, I would either be dead or in the ICU by now.

She also suggested that the itching/tingling in my finger could be due to nerve damage suffered from the burn. Strangely enough, the sensation has largely subsided since meeting with her yesterday. If I could just get past these odd back/neck pains, I think I would finally be able to relax.

She did not suggest I take any sort of test for rabies and/or rabies immunity, and I didn't push for it.

At the very least, I feel more optimistic today than I have for at least the last week. Thanks again everyone for the reassurances, and for bearing with me through my extreme anxiety and paranoia.

Oh, and she also suggested I consult a psychiatrist to help work through this extremely stressful experience.

Thanks as always for your input Sheryl, and I sincerely hope you're right. If I do get through this I agree something needs to be done about this anxiety - it's controlling my life.

Thanks for all that info, but I'm still freaking out here. For one thing, as I mentioned I was living in Kamphaeng Phet, where I doubt much effort has been made at vaccination.

Beyond that, it seems odd that my severe headaches could have been caused by taking just 5mg of Valium per day. On top of that, today my pupils have been noticeably dilated while indoors, though they constrict when in sunlight. I also continue to feel the itching on my finger.

Am I going crazy? Can you experience withdrawal symptoms from just 5mg of Valium per day? And are dilated pupils a symptom of that withdrawal?

^Point taken.

Thanks for all the reassuring comments, it is hugely appreciated. As I mentioned before, I do have a history of anxiety and hypochondria, so I'm hoping that's all this is. However, I've now been experiencing these incredibly intense headaches for 8 days. They subsided a bit yesterday but have returned with a vengeance today. Like most people I've had occasional, minor headaches in the past, but nothing on this scale.

The itching/tingling sensation in my finger comes and goes, which makes me think (hope) it is a manufactured symptom.

Initially I did attribute the headaches to valium withdrawal, as they did start just when I was attempting to ween myself off of them. But even after I resumed taking them at the same dosage (I haven't increased at all), the headaches remained. I've stayed at 5mg per day and never more. Is it possible the headaches are due to my body craving higher doses?

Regarding the statistics about rabid dogs in Bangkok, I find that both reassuring and troubling. It's reassuring because according to a 1998 study I found, 54% of strays in Bangkok were found to be rabid. (abstract here: http://www.ncbi.nlm.nih.gov/pubmed/9593486) But I understand a massive vaccination campaign has been undertaken since then, so the statistic you've cited is probably accurate today.

However, it is troubling because I was not living in Bangkok. I was living in Kamphaeng Phet, and the park where we found the cat had a couple of packs of roaming dogs -- one of which I never saw again. The cat also had a wound on his back, but since he survived another 60+ days I guess rabies could potentially be ruled out. After all, quarantine time in most countries is 30 days.

The vet we took him to seemed to think he was suffering from feline leukemia, although no tests were performed and few questions asked. In fairness, the cat's symptoms did exactly match those of feline leukemia, except for the foam pooled around his mouth when we discovered his dead body. However, the foam did have a definite yellowish hue, so perhaps was the result of vomiting with an empty stomach. There also appeared to be tiny amount of blood in the foam.

We ruled out poisoning simply because he had been locked in the house for a full 2 days before his death. If he had ingested poison, could he have lived 2-5 days before dying? I really don't know.

Anyway, I agree that I need to get a handle of my stress/anxiety. The last month has been one of sheer terror from start to finish. And every doctor I've talked to (and there have been a few) has said the same thing: the cat might not have even had rabies, and even if he did our risk of contracting it was extremely low, even with the burn wound (it was approx. 5-7 days old at the time).

If these headaches would go away I might be able to put this behind me once and for all, but until then I'll be trapped in this vicious cycle of anxiety and fear.

Thanks again for all the advice and replies. It is greatly appreciated.

After taking quite a bit of pain meds and getting some rest, the headache seems to have subsided.

But FBN, I'm curious about the measures that you mentioned might be available. I've read somewhere that amputating the infected limb can stop the progression of rabies.

When is it too late to do so? If a person is already experiencing symptoms such as tingling/itching at the site, and headaches, is it too late for amputation to be effective?

Thanks FBN. But I'm not sure you can say it's too early for the headaches to be caused rabies. The median incubation period in the United States is 36 days -- I'm at about 34 days post-exposure at the moment.

I had 1 g of paracetamol earlier this afternoon which didn't help at all. But after having 500 mg more about an hour ago, followed by a beer, the headache has largely subsided.

If the headache were caused by rabies, would the pain ease with simple alcohol and paracetamol?

I'm hoping if I can just get a good night's sleep it will go away. I haven't been sleeping much at all these last couple of weeks. And when I woke up this morning, in spite of having only a few hours' sleep, the headache was not present, so, hopefully, that's all it is. I just don't know, but it's absolutely terrifying.

Oh and FBN, I presume you are referring to the Milwaukee Protocol. According to the CDC I wouldn't be an eligible candidate, because I received the final vaccine booster after these symptoms had started (the headaches).

Also, the Milwaukee Protocol is inconsistent and as yet unproven -- there have been only 4 documented survivals so far. And anyway, Singapore being a rabies-free country I'm not sure they'd have the docs and equipment available to attempt it.

I'm in Singapore now, I arrived here yesterday. I wanted to be close to my parents (who live there), and also have access to a better medical system.

I went to a hospital this morning which supposedly specializes in communicable diseases. I was told that this particular hospital had the means to test for rabies, but this being Chinese New Year that particular clinic was closed.

I did have a long talk with one of the doctors. He agreed there was a significant risk but tried to reassure me that my symptoms are more likely due to lack of sleep and intense stress. He prescribed some pain meds, but in spite of taking them the headache remains just as severe.

Thing is, this morning, while talking to the doctor, the headache had pretty much subsided. It wasn't until I arrived home, early afternoon, that it returned with a vengeance.

I have a history of anxiety attacks so it's becoming difficult to know what are genuine symptoms and what are manufactured, but this headache is unlike anything I've ever experienced. The itching/tingling sensation in my finger comes and goes -- sometimes I feel it, sometimes I don't.

The doctor said if the feeling spreads, or if I feel pain shooting up my arm, then I should be more concerned. He thought this particular tingling/itching might be due to my extreme paranoia and overactive imagination, but I'm not so sure. It's true that I didn't feel it at all immediately after the visit, so perhaps my mind is playing a role here.

But it's the headache that's really getting me, because it is real. Has anyone heard of such an intense, steady headache, encompassing the entire head at times and specific parts at other, being caused by stress/lack of sleep?

I really fear the worst.

Well I'm afraid it looks almost certain that I have rabies. The girlfriend seems in the clear, but not me. This is not a joke. This is real.

At the time of our exposure, I had the remnants of a burn wound on my index finger. It was perhaps one week old, but I had just peeled the dead skin off, revealing the tender, as yet not fully healed skin below. At the time I wasn't worried about it, because I mistakenly thought the virus needed access to the bloodstream. Not so. It merely needs access to the nerves, and a second degree burn does not adequately cover the nerves for 2-3 weeks afterwards.

So all the virus-laden saliva was all over the exposed nerves of the second layer of skin.

For days now, I've been having the most severe headaches of my life. Never before have I experienced anything like this. At first I attributed it to stress and my newfound valium addiction. However, the headaches have become steadily worse, and are to the point that now I can't even sleep at night.

Combined with this is the disturbing fact that the site of the old burn wound is now tingling/itching, ALL THE TIME. It won't stop. This is, almost without a doubt, rabies.

There are two options here: I'm having a nervous breakdown and manufacturing all of these incredible real-feeling symptoms, or I have rabies.

If I last the night, I'll be heading to the doctor's tomorrow. But I fear the worst.

What do you guys think?

It would be the end of her world and possibly mine - if she has it there's a fair chance I do, too. The doctor seemed to think her symptoms were not indicative of rabies, but given the non-specific nature of symptoms of the prodromal stage, his assessment wasn't very reassuring.

I guess I'll see how we feel tomorrow.

I should stress that her symptoms are unlikely to be manufactured due to stress; she is not worried about rabies at all, since she believes the vaccine alone, started four weeks ago, should have been 100% effective.

I'm afraid this story won't end. My girlfriend continues to experience strange symptoms - the lower back pain expanded to include the entire pelvic area. She was noticeably anxious, so we visited a private hospital in BKK where an ultrasound was performed to rule out cysts. Nothing strange was observed, but she was given a load of antibiotics and some painkillers. The next day (yesterday) she seemed fine, but then last night she tossed and turned all night, then woke hours before her usual time and couldn't sleep again.

She's been plagued by a feeling of general malaise all day today, and has been unusually grumpy. The timing and symptoms coincide perfectly with rabies, so again I'm fearing the worst.

I'm also fearing the worst for a few other reasons. One is that the doctor we spoke to at the hospital the other night wouldn't rule out the possibility of rabies. He said based on our exposure the risk was low, but admitted that it was possible. He suggested we get tested (there is a non-invasive test to confirm, apparently), but we were too afraid to do so. He also confirmed, as did some other studies I read about on the web, that the PNS is an immune-protected environment, meaning that once the rabies virus enters a nerve, it is too late.

I also read a US study which suggested that superficial bites on the extremities carry an estimated 5-10% risk of contracting rabies. My girlfriend was bitten on the finger by the cat. It did not appear to break the skin, but isn't there a possibility that the virus was able to gain access to a nerve? We didn't start the vaccine until 36 hours after the bite, so that means if the virus had entered the skin near a nerve, it had about 8.5 days to penetrate the nerve before an immune response could be mounted.

So yes, I may seem paranoid, but isn't there good reason for me to be worried, in light of these unexplained symptoms?

Does the 'affirmation of freedom to marry' form have to be from your embassy in Thailand, or can it be obtained abroad?

They had a poster up in the ER describing the correct administration of ERIG, so they may have had it on hand.

Perhaps a stupid question, but one I'm having difficulty finding an answer to. If the virus has reached the peripheral nervous system, can the immune system (boosted by the vaccine) still fight it? I know once it reaches the central nervous system the answer is no, but what about the PNS? Because it would seem the virus reaches the PNS within days.

do you know his name? would be useful.

I'm afraid I don't remember since it was a few years ago, but I've routinely gone to Bangkok Christian for medical care and always been impressed.

Thanks FBN, I appreciate it. Once I make it through this week I'm sure I'll be able to relax. The problem is that, as I mentioned above, I read a CDC report which discussed the fact that the vast majority of PEP failures (minus HRIG/ERIG) occur in days 14-28. We're at day 22 now, so almost in the clear.

Thanks again for bearing with my extreme paranoia.

I appreciate the response, FBN. But let me play devil's advocate (and hope you can reassure me). If the potential exposure was on the finger tip, wouldn't the incubation period be much faster? It's a part of the body that is quite rich in nerve endings.

Also, I have read of cases where rabies did present itself first with back pain.

This nightmare won't end. My girlfriend is now experiencing strange back pains, enveloping her lower back and towards the hips. This is a symptom she has never experienced before, and it does seem consistent with rabies. I'm freaking out all over again! She has felt the pain since the day after her bout of suspected food poisoning.

What might this be, if not rabies?

I had a worrisome mole removed from my back a few years ago at Bangkok Christian hospital on Silom Road. Perhaps I was lucky, but the GP I ended up seeing had worked in Florida for years so was highly familiar with skin cancer. He suspected that my particular mole was not cancerous but agreed I should have it removed and tested just in case - it was benign, thankfully. But all around professional service and very knowledgeable doctor.

Thanks again, Sheryl. I know you're absolutely right, but it seems the mere prospect of having been exposed to the rabies virus has brought out my neurotic side. It doesn't help that my girlfriend tends to be a bit of a worrier as well, so we've been feeding off each other's fears.

She is significantly better today though still not 100%, but I suppose that's to be expected with food poisoning. Hopefully we'll be able to put this all behind us once she recovers completely.

Well the nightmare continues. Last night my girlfriend was up at 3am with diarrhea and vomiting. She felt extremely hot, so fearing the worst we set out to the hospital emergency room.

The doc said she didn't have a fever, and said it looked like food poisoning. They gave her an IV of some kind then sent us on our way. I repeatedly asked if it might be rabies, and the doc said no because, get this, my girlfriend wasn't afraid of water or air.

Now, I know that hydrophobia and fear of wind are common symptoms in the later stages of the disease, but isn't vomiting one of the earliest symptoms to be exhibited?

We're freaking out here. We're in Bangsaen now, as we were too stressed out up in Kamphaeng Phet and needed to get away in the hopes of relaxing. So much for that.

Does this sound like it could be rabies?

Thanks, Sheryl. That's exactly what I needed to hear. The human mind does indeed react to fear/stress in strange ways.

I mentioned earlier that my father was given rabies PEP when he first came to Thailand in 2006. At the time and throughout the first few weeks of PEP he was seriously worried about it, in spite of my repeated assurances that he would be fine. His response: "It's easy to say that, but it's different when it happens to you."

So statistically it's easy to conclude that the risk is extremely low, but when any potential risk to your life exists at all -the mind has a tendency to forget about statistics and, in many cases, focus on the slim possibility of a worst-case-scenario.

I hope anyone reading this thread takes away two very important lessons: Always vaccinate your pets, and get the pre-exposure rabies vaccine if you live in place with a high prevalence of rabies - like Thailand.

Not exactly the consolation I was hoping to hear. But would you say my exposure was relatively low risk? My fingers came into contact with the cat's saliva on several occasions, but he never bit me. He did lightly bite my girlfriend's finger, but it didn't break the skin. The rabies virus cannot penetrate healthy, intact skin, right?

So do you think there is much cause for worry here?

Well it's day 16 from the first exposure (hand-feeding the pills the first day), and day 14 since starting PEP. I'm still freaking out about this, knowing that the vast majority of PEP failures take place during days 14-28. I know the odds are on my side, but I'm still going crazy.

Any words of advice or consolation? I can't get my mind off this.