Did Montelukast save my life?

Back in March I had the virus (COVID-19) but not in the same way as other people. I spent a scary night aching all over like the flu. My partner and I both had dry coughs and what is left of my sense of smell was eliminated. Later as I recovered I notice that much of my food tasted strange and sweet things were obnoxious. There was no fever.

There was rudimentary diagnosis from the NHS 111 service - and so we self-isolated - but this was never recorded anywhere. We think we got it from someone on the London Underground.

At the time loss of smell and taste was not recognised as a symptom and it was thought the disease behaved much like flu. Now doctors and scientists think differently.

When it happened I had taken Montelukast several times in the previous days as I had been to a number of functions and meals. And spring was starting up.

Could Montelukast have saved my life? It is now known that one of the ways the disease causes its damage is through an over-reaction of the immune system, of the white blood cells. Montelukast suppresses part of the immune system, the leukotrienes, a kind of white blood cells.

This study, http://www.englemed.co.uk/20/20aug101_covid19_eosinophils_link.php, found that eosinophils, the precursor of leukotrienes, are the main source of immune system over-reaction in COVID-19 infection.

So did Montelukast save my life? That night I went to bed wondering whether I would wake up in intensive care. As I say the symptoms were unusual - no fever and the aching all over - but they were unpleasant and frightening.

I have also read that people with asthma have proved surprisingly resilient against the virus - they have not faced the high death rate experienced by others who were believed to be at risk. Steroids, which also form the basis of asthma treatment, have now been proven to be an effective treatment against the virus. Could Montelukast be a useful preventative treatment for some of us?

Six months later I count myself as among those who have not fully recovered from infection. I have experienced a strange congested feeling ever since. In the spring and summer I put it down to hay fever and took more Montelukast. However I don't like taking it in the winter as since it is an immune suppressant and I get concerned it could make me vulnerable to flu. I have just had a screening blood test ordered by the GP and the one measure that is out of sorts is my white blood cell level - it is low. I might have taken Montelukast a few days beforehand. I cannot remember as it never occurred to me it might be a problem. It could be a legacy of COVID-19 infection. I wonder if the GP will know?

Indeed earlier this year I went down with flu in spite of having the flu vaccine (so it is very unlikely that my episode in March was another bout of flu). I was let down, I think, by my unstable immune system. The choice of whether to take Montelukast during the winter is now even harder.

RAS

Branded!

The splodge is on the way back and it looks as though I've been branded. There are two neat markings on my chest, one a half moon and the other slightly larger than a penny. The truth is they itch a little - and the itching makes me scratch. They are clearly growing.

I've not been taking penicillin or eating stilton cheese so it's a bit of a mystery.

However after several weeks of indulgence - could this possibly be the reason? - I've resolved to carry a stock of montelukast with me at all times and to take it daily. There have been weddings and banquets and business meals and all sorts of events. And frankly I've nearly given up  trying to get my special diet recognised. When I have a choice I choose fish - but the chances are it's cooked in a rich broth of herbs. And at weddings and set piece meals, you don't get a choice. The best you can do is to get the waiter to take it away and scrape off the gravy. Might as well do it myself.

At the wedding I toasted the bride and groom with champagne and nearly choked on it. I'm not convinced about shallots either - we keep a stock for cooking but I really don't like them, nor does my throat.

All this needs a pill beforehand and a pill afterwards

When we had a brief bout of hot sunshine in the UK I exposed myself  to it - but it was not enough. We are planning our summer holiday in a hot location so I'm hoping it will scorch the splodge away before it covers my whole chest again.

I hope so because I really cannot imagine going to my GP and explaining how I got an enormous rash over my chest.

RAS

Reflections and reactions after Christmas

I seem to be ultra-sensitive to salicylates again - and it's all my own fault. Just a little bit too much self-indulgence over Christmas.

For instance tonight I was picking the purple chocolates out of tin of Cadbury's Roses. These have a nut, surrounded by sweet toffee in a chocolate shell. No I did not eat the nut - it was easy to eat the chocolate and the toffee, remove the nut from my mouth and throw it away and nobody else in my family likes nut chocolates - so nobody would complain.

It didn't work - it was clearly too much exposure as my throat rapidly swelled up. It's been the same for days. Every small breach creates a reaction. On New Year's Eve I was at a party and was offered some mini spring rolls on the grounds they probably contained beansprouts and carrots. I wish. They contained some nasty mushed vegetable goo. On Sunday my other half pointed out I had sprouted a rash on the left side of my face. I also had jaw-ache on the left hand side. I took a montelukast last night and another one tonight.

So what does this say? I had three glasses of wine over Christmas - two on Christmas Day and one on Boxing Day - in spite of resolving not to. Reviewing the experience of previous years, it seems as though the effects of wine are long-lasting. I used up whatever tolerance I have - even with the aid of montelukast.

I wonder whether I can resist in Christmas 2012?

RAS

Granny's remedies

By yesterday morning one eye was bloodshot and had been for two days without any sign of healing. The other was aching and I was losing hearing in the left ear. It was definitely the worst cold I've had since I've had this problem and, worse, it was persisting.

Out of necessity comes invention - or rather reinvention. I remembered getting sinusitis and bad colds as a child. I also know well the symptoms of the other kind of sinusitis, call it inflammatory sinusitis if you like as I'm probably not meant to call it allergic sinusitis. Maybe non-allergic sinusitis to rhyme with non-allergic rhinusitis.

Anyway this was not non-allergic sinusitis, it was viral sinusitis. And the old remedy involves getting plenty of steam and sticking your face in it. This is what I did. It flushes the virus out of the cavities of the face. I combined this with some new tricks - like swallowing to open the  eustachian tubes and flush anything down from the ears. And, as my throat was quite lumpy, I put some salt in some hot water and gargled it.

Within a few hours I was cured. The blood went from the eye as did the aching. I haven't had a chance to test the hearing. At best all that remains is a mild cold.

So what on earth happened? My hyperactive immune system is meant to see off colds - and in case of doubt I thought to get it going with redbush tea and even a glass of wine. My theory is this and I'm no immunologist. The immune system works in several waves - the first is the blunt response to stave off infection. That's what you get when there's a salicylate reaction. Later on the immune system fine tunes itself to deal with particular viruses.

Now for the last five years I've barely had a cold or flu because it's been seen off at the outset. So there's been no fine-tuning against new viruses. The effect is similar to Native Americans or Martians being exposed to the European common cold. I'd lost my immune protection.

So once the virus got through I was vulnerable - and ended up spending two days and many more hours in bed together with a nasty bout of sinusitis.

RAS

PS In researching this I went back to several of the Wikipedia sources to make sure I'm not talking utter nonsense. Taken together they are very good. The article on salicylate sensitivity is good but you need to follow the link to Montelukast and on to leukotrienes, the arichidonic cascade etc to get the full story. The front-line immune cells are called neutrophils and they appear to be guided by leukotrienes, which also cause inflammation and hence asthma and other symptoms of allergy.

Side-effects of Singulair

There's a new side-effect from montelukast reported by the US authorities here. And it's psychiatric. Actually it's not new but for some reason it's just hit the social media.

The range of effects includes "agitation, aggression, anxiousness, dream abnormalities and hallucinations, depression, insomnia, irritability, restlessness, suicidal thinking and behavior (including suicide), and tremor. "

I can't say I had noticed - I was like that (irritable and restless) before I started taking the drug so I will ask members of my family. If these effects exist they are nothing like the side-effects of anti-histamines. I had a relative who went through a period of temporary madness and lost the ability to distinguish between dreams and reality. That was how anti-histamines, taken in high doses regularly, felt. Deep, realistic and frightening dreams.

I wonder if some of those who have reported side-effects have confused them with the effects of anti-histamines which they might well have been taking also.

* In fact I think I'm much calmer now than I was five years ago, perhaps thanks to giving up caffeine. Can I report a beneficial neuro-psychiatric side-effect?

RAS

Pink fingers

Easter weekend was going to be challenging as we have had a great deal of family festivity. And we are enjoying an astonishing bout of late April sunshine - the air is awash with various kinds of seed, blossom and pollen. I don't get allergic hay fever, so I'm told - but I seem to get pseudo-hay fever caused by exposure to floating vegetable matter.

I've been taking montelukast daily for the last few days - and have also concentrated on eating fish - following the reappearance of the speckled rash on my belly as well as the odd symptom of sinusitis.

We went to a Thai restaurant, where I ordered prawn crackers, trout and egg fried rice. You never know for sure what other spices and herbs have been added - I was hoping not too many to these dishes.

When I pressed anything against my fingers during the meal, a bright pink rash appeared. At first I thought it was just my index finger, which I'd burnt on a light bulb the night before. I thought it was a kind of blistering - but it did not last long. However these rashes appeared on the fingers of both hands. They were a kind of bright pink - I tried to find the colour and consulted this site http://www.december.com/html/spec/color4.html. Spicy pink perhaps? Well it was a Thai restaurant.

Today there is no sign of this happening. Weird.

Using the ever-helpful Wikipedia I've found a benign condition called dermatographic urticaria. It seems the best explanation for the moment.

RAS

Montelukast!

Montelukast - at last!

I popped in to the doctors' at midday and there was no queue. Nor was there a repeat prescription waiting. The receptionist admitted there had been some problems with email - in fact I think they've changed the address.

However she was very helpful and printed off a repeat prescription and then went off to find a GP to sign it. So I take everything back.

I popped a pill as soon as I got home. I certainly feel better now - the eye's not so sore, the jaw's barely aching and the Splodge is hardly itching. Maybe another tomorrow.

RAS

Pain and gain

I think I overdosed on redbush tea.

Last night and this morning I had an aching pain in the index finger of my left hand - and a fair amount of aching on my left arm.

I took it to mean I had overdosed - and in fact when I woke up this morning there were few signs of the cold. And Australia, which was the Splodge, was quite red.

So I've given up redbush tea again and taken up decaf instant coffee - which doesn't taste too bad now. Tonight I took a montelukast and the ache has almost gone.

RAS

Chocolate cake

 Last night I had a piece of chocolate cake. This morning my arms are covered in bright red lumpy spots. I've taken a montelukast.

RAS

Flu!

 I'm not sure if my weekend excesses were responsible but today I woke up and discovered the dreaded flu bug had struck - seemingly out of the blue. My voice was all but gone and my shoulders and upper chested ached. I thought something was wrong after the weekend when I did indulge in quite a bit of wine. At the time I seemed not to suffer any ill-effects but I began to get uncomfortable by Monday. Now it seems it was a virus gestating.

I took two montelukasts over the weekend, the first in some time. I wonder whether they weaken the immune system. Whatever has happened, on this occasion my once hyperactive immune system has not saved me.

I've just eaten a Bakewell tart to get my blood sugar levels up and wake me up to do this entry. It contains jam and coconut. Based on my experience with my first cold before Christmas, I might have hoped not to suffer reactions because of the virus infection. Not this time. I think it's just aggravated the discomfort in my throat.

RAS