We were walking home after a busy day at the shop. My friend, an experienced diving instructor who had done prior work in landscaping, gave us an impromptu tour of the surrounding flowers and trees. One of these included a cashew tree, something I had never seen before in person. He separated a raw cashew shell from the fruit and split it open. Fascinated, I took it and ripped it open further in order to display the nut. He casually mentioned that the shells are toxic, but I took this to mean that the shells could not be ingested in their uncooked state.
It turns out that this was a wildly incorrect assumption. This simple mistake sparked a chain of some crazy events during my trip through Costa Rica and Nicaragua.
I developed a rash on both thighs within a couple days’ time. There was no reason for me to think back to my run-in with the cashew shell, so I assumed that this rash came from something scuba related. Then my legs began to itch, starting from a minor annoyance to an unmanageable irritation. The rash expanded in size within a few more days, just to prove that it wasn’t leaving anytime soon. It eventually got to the point where the reaction spread to my fingers and abdomen.
By this point, I had no idea what was wreaking havoc on my skin. WebMD wasn’t very helpful, other than its typical MO of alluding to a 35 percent chance at a terminal condition. The solution came in the form of a casual conversation. I happened to mention the reaction to my friend, who then showed me a similar rash on his own skin. It seemed hard to believe that touching a cashew shell could cause that strong of a reaction, but at least I had an answer.
Cashew shells contain anacardic acid, which is chemically related to the allergenic oil of urushiol. This same oil causes the allergic reactions commonly seen with poison ivy. It turns out that the oil was all over my hands from opening the shell, and it was never properly washed off.
My friend’s rash cleared up without any treatment, and my condition took a different course. It eventually got to the point where the reaction had spread to my face. I had just woken up on my final morning in San Juan del Sur, where we planned to take a 9:00 AM shuttle to Granada. After a generous freak-out about the state of my face, we decided to seek out a pharmacy once in Granada. Upon our arrival, we found the Nicaraguan version of Claritin and paired it with calamine lotion.
I hoped that a simple regimen the antihistamines and anti-itch cream would help clear things up. I knew that my condition had transitioned from nuisance to serious, now that the rash had spread to my face. If over-the-counter medication didn’t work, I would need to see a doctor for steroid treatment with stronger antihistamines in order slow down the allergic reaction.
Sure enough, the rash worsened throughout the day and my face began to swell. I decided at bedtime that if the swelling had not gone down by the morning, I would seek out a hospital for further care. Unfortunately, I woke up in the middle of the night to additional swelling. I started crying because I couldn’t even recognize myself. Nothing seemed more terrifying to me than going to a hospital in a foreign place, but knew that it was my only solution. Steve helped me calm down, and found a reputable private hospital in town that we could visit in the morning.
Pretending to laugh it off. My face looks like it just encountered a bee’s nest.
We had breakfast at our place, where I hid my face behind a hat and my eyeglasses. I felt incredibly self-conscious. I kept my head down and ate in silence, until the owner made an empathizing joke about how I was going to float away if we couldn’t figure out a way to bring the swelling down. He slipped me another pancake and assured me that I would be in good hands.
We grabbed a cab and departed for the Hospital Privado Cruz Azul. Upon arrival, we found ourselves confused as to whether this was the right place. The map showed that we were at the public hospital, but the name on the building aligned with where we expected ourselves to be. We were lead to a random window in a deserted hallway, where we filled out paperwork, and then proceeded to a waiting area.
In Nicaragua, a public hospital will give you a free consult on your condition, where you only have to pay for procedures and medications. Private hospitals have a co-pay of $30 on top of those procedures or medications. Private hospitals benefit from shorter wait times, and we believed that the quality of care would be better there as well. I will add a disclaimer that we had no evidence to back that assumption. Deciding to take the safe road, we opted for the private care.
I started to realize that the hospital only spoke in Spanish. I have a baseline fluency in Spanish, at least when it comes to ordering food and partaking in casual conversations. But speaking Spanish in a medical setting was a whole different beast. As someone who adamantly avoids Google Translate in Spanish-speaking countries, I felt more than happy to whip it out in order to find out what was wrong with me and how they planned to treat it.
Trying (and Failing) to Keep it Together
Overwhelmed definitely feels like an understatement. I was in a foreign hospital, scared, and struggling to understand what the hell they were going to do to me. And that’s when they whipped out the IV needle that would be used to administer my medication. As someone who has multiple tattoos and piercings, you would think that I wouldn’t be afraid of needles. But I hate when they are sticking out of me, as I feel unable to control the feelings of panic.
To make matters worse, they couldn’t find a vein for the IV. After a minute or two of looking for it, I started to lose my composure. Picture a 25-year-old woman, crying and shaking, while getting poked with needles. It’s not a sight that I’d like to repeat. It turns out that I wasn’t the only one who was struggling. Steve told me later that it took everything that he could to not freak out as well. Once they found a vein, the nurses administered the medications and moved me to a separate room. I waited there while the medication took effect, where the doctor regularly checked up on my progress.
The final diagnosis was a strong allergic reaction to the cashew plant. They treated me with a powerful antihistamine to give me relief from the itching, along with a corticosteroid to slow down the effect of the allergic reaction. These would reduce the swelling and eliminate the itching sensation for a quicker recovery.
After a couple of hours, the swelling and rash had improved drastically. The doctor seemed happy with the results and released me with a couple of prescriptions to fill. I have to give her credit, she was incredibly patient with the language barrier. It couldn’t have been easy to diagnose someone who struggled to understand what she was saying, but she waited to answer all questions before proceeding.
Believe it or not, this is an improvement. My face appears blotchy due to the reduction in the redness and swelling.
This experience also opened my eyes to just how expensive medical care can be in the States. The office visit, medications, and prescriptions cost a grand total of just under $50. I’m willing to bet that the same visit in the States would have put me out hundreds of dollars. Even though Nicaragua wasn’t at the top of my list for ‘where I’d like to have an allergic reaction’, I was impressed with the quality of care and the price tag that came with it.
I spent the rest of the day laying low at the bed and breakfast in order to recover. Within a couple of days, my face looked completely normal again. We proceeded on with our travels as we had before, and ended up enjoying the rest of our trip.
This ordeal makes for a pretty interesting story, but I would be happy to avoid a repeat performance. Travel can be fun, but take this as proof that it’s not always as perfect as the pictures make it out to be. You will run into nuisances that have the potential to debunk an otherwise amazing experience. I don’t plan on avoiding anything with manageable risk in the future (except maybe cashews), but I understand that there will always be issues outside of my control. My plan is to live my life fully and responsibly without being owned by the fear of a potential risk. I can roll with those problems as they come.