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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17961
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I'm rather concerned about my wife who is receiving medical

Customer Question

Hi, I'm rather concerned about my wife who is receiving medical care from a local Cambodian who has performed a house call at our hotel.
The background.
We have been travelling through turkey, momgolia, India, the north of Thailand and now Cambodia.
Yesterday morning (3rd dec) in Koh Rong (small cambodian island with no doctor) at around 2am she started to experience diarrhea but it also came with a sweltering fever and a very sore body. She especially complains about her back and being unable to get comfy.
I booked the boat off of the island as soon as possible today the 4th at 10am.
Now this is a long time, so I visited the local pharmacist / convenience store guy who threw the simple combination at me. Ciprofloxacin and paracetamol plus rehydration sachets.
I worked tirelessly to try and keep her temperature lower, by sponging her head, keeping her out of sunlight and constantly fetching Ice and water to make a cold forehead pack. And mostly the fever was kept at bay. But obviously when the efforts slowed (when i was sleeping) he fever spiked again.
I've been trying to keep on top of it, but we just got to the mainland and the non English speaking doctor that they called up to our room proceeded to put a LRI drip into her for rehydration (I thought this was overkill since she has been keeping her fluids up and is able to drink.)
Then he proceeded to inject into her rear an ampoule of
2mL METAMIZOL (1000mg metamizol and 10mg lidocain) and then an ampoule (2mL) 200mg cimetidine.
This was followed by a multivitamin and another tablet with no obvious medical branding.
Should I be concerned about this concoction? As I was thinking bed rest in an air conditioned room, more paracetamol and cipro while she keeps hydrated should have done the trick.
I am however concerned that her fever hasn't broken, and when measured here an hour ago it was 39degrees. But i know it was hotter last night because when I felt her head it was boiling and I was working very hard to lower her temperature, so I worry that the temperature could have well been north of 40 last night.
What should I do? Stay here and let this guy treat her, or try and make a run for a bigger clinic?
Just a concerned husband hoping that the doctor here is actually taking the best actions.
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. D. Love replied 1 year ago.
Hello from JustAnswer.
Is the diarrhea and the body soreness improving compared to yesterday?
Is she having any nausea or vomiting?
Is she otherwise acting and thinking normally or is she acting confused or having difficulty thinking clearly?
Customer: replied 1 year ago.
The diarrhea and pain is marginally better than yesterday (before the additional iv and unknown meds) but its "still bad" (her words)Yes there was nausia and vomiting.When her temperature was at its highest yesterday she was very dizzy and uncoordinated and I had to help her to the bathroom.
Since that peak and her current condition she says "Im fine" (again her words)
Expert:  Dr. D. Love replied 1 year ago.
Thank you for the additional information.
Although the fever is one factor to consider in whether she should be seen elsewhere, it is actually the severity of these associated symptoms that is the better indicator of whether she should be seen. If she is having more severe diarrhea, abdominal pain, nausea, vomiting, or altered mental status, then it would be better for her to be seen, and it may be necessary for her to be admitted to a hospital, if there is a hospital close to your location.
If these symptoms are improving, then it would be OK to try to continue the treatment that you are currently doing. The Cipro is the best oral antibiotic that can be taken for this type of infection, since it covers the common bacteria that can cause this type of infection. A more severe infection may require IV antibiotics, but that would mean that she would need to be in a hospital.
As for the fever, there are a couple of options to consider in this situation. The paracetamol is reasonable as the primary oral medicine to relieve the fever. It also would be OK to also take ibuprofen in between doses of the ibuprofen to augment the effect, since it works via a different mechanism. The ibuprofen can irritate the stomach, so may not be well tolerated in someone with a gut infection and already having some nausea and vomiting, but if she can tolerate it, it will usually help. It also would be reasonable to adjust the skin treatments that you are using to achieve a more sustained temperature reduction. Using ice can achieve the quickest lowering of skin temperature, but in some people, this can be counterproductive, because the rapid lowering may cause internal shivering and an increase in core body temperature. Instead, it will usually achieve a longer lowering of the temperature if it is achieved more gradually by sponging lukewarm water over the skin. It is the evaporation of the water from the skin that removes heat from the body, so soaking in lukewarm water will not work. However, sponging the lukewarm water over the body and allowing time for it to evaporate and then repeating the process multiple times will lower the temperature. It may take longer than using the ice, but it will typically not cause an increase in core body temperature, so the temperature reduction will be more sustained.
As for the medicines in the concoction, there is no reason for concern about the concoction, These medicines will not alter the underlying condition, although they may help ease symptoms. The concoction, though, would not be a substitute for appropriate IV treatment for a severe infection.
If I can provide any additional information, please let me know.
Customer: replied 1 year ago.
The issue I have is I have been told to stop giving her paracetamol and the cipro.This seems like bad advice to me, and she is currently on an IV in our hotel room. I suspect (call me cynical) that this may be some prolong your stay in out hotel while she gets treatment scam.
Do you think the medications that they have started administering and telling me to stop administering cipro and paracetamol is correct advice?
If I were to also give her cipro and paracetamol would it have any side effects to the drugs he has given her?
I guess I just don't trust him as I would have thought paracetamol and ibuprofin were key for temperature control and the cause of it is most likely bacterial hence the cipro..
I worry that by allowing him to administer these other drugs.. The metamizol and cimetidine and keeping her on an IV, that he may not be best treating the condition
Expert:  Dr. D. Love replied 1 year ago.
If there is no antibiotic on the IV (and none of the medicines that you listed above were antibiotics), then I would not be comfortable with stopping the Ciro and paracetamol. The metamizol does have action to reduce fever, and would be OK if it works, but I find that the paracetamol works as well, if not better. But without an antibiotic, I would be hesitant to stop the Cipro, and is not consistent with how this is treated in the US.
It is worth noting that mild bacterial infections of the gut are frequently not treated with antibiotics, so a recommendation to not use antibiotics is not as bizarre a suggestion as may be at first supposed, but when the infections are more severe, then antibiotics are appropriate.
If I were in your location and one of my family were this sick, I would not be comfortable solely using the treatment regimen recommended by this doctor and while I would judge how sick the family member looked to me, it sounds like this is such a severity that I would seek care elsewhere.
Customer: replied 1 year ago.
It turned out one of the tablets I had to give my wife was CF 500 (cypro). So that relived me a bit.My wife's temperature has decreased since today's treatment. But he came back with the following blood test.I'm not a doctor, but I think he suggested that she has typhoid?
I'm pretty sure she was vaccinated against this, and the reading of 1/320 titres for the O count really doesn't mean much to me, other than antibodies are detected at a weak level.Would the treatment be the same? Cypro and paracetamol? Because I am feeling myself becoming ill and if I can nip this in the bud I will. As we eat and drink everywhere together and share food and drinks, so its likely that if I'm coming down with something it may well be similar.Also, what is the recimmended dosages for cypro?
Expert:  Dr. D. Love replied 1 year ago.
Typhoid certainly is one of the common bacterial infections. This blood test is not the most accurate for diagnosis of typhoid, but the most accurate test, a culture, will take a few days to return
Cipro is one of the common antibiotics used for typhoid, although local bacterial sensitivity patterns are the best determinant of proper antibiotics.
The treatment for each of you would be the same, although the paracetamol is only needed for relief of fever. The dose of Cipro would be 500 mg twice daily.
Customer: replied 1 year ago.
Thankyou for your insight.
Yes I have been googling, but there is a lot of information which may be misleading if you just follow it yourself.
I feel assured that I'm doing the right thing now.
Thankyou.
Expert:  Dr. D. Love replied 1 year ago.
You are most welcome. I am glad I could be of assistance.
If I have answered all your questions, please rate my response Excellent (click on the 5th star).
However, if I can provide any further information, please let me know.
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17961
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
Dr. D. Love and 2 other Medical Specialists are ready to help you
Customer: replied 1 year ago.
Oh, one last thing if I may.
Can she eat pizza now that her fever is gone and she's on a course of antibiotics?
Customer: replied 1 year ago.
Oh and how do I change my rating? I should have given you 5 stars. But its saying 4 up top.
Expert:  Dr. D. Love replied 1 year ago.
It is good that the fever is gone.
If she is not having significant nausea and vomiting and her appetite is coming back, then it would be OK to increase her diet, as tolerated. Pizza would usually not be the best first solid food to introduce, but if she has been eating other foods without difficulty, then it would be OK to eat pizza. If she has not yet had solid food, it would usually be better to introduce foods that are more easily digested, such as the BRAT diet - bananas, rice, apples, and toast - and then use add other foods if these are tolerated.
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