The fish fought back

 

Playa Cosón is nothing less than a living postcard, with its brilliant white sand, swaying palm trees, and vibrant turquoise waters breaking foamy white just off shore. Children ride the playful surf on boogie boards, laughing and high-fiving when they all catch the same wave all the way to the beach. The sun smiles down on that beach beneficently, encouraging beachgoers to don their sunscreen, and the coastal mountains of the Dominican Republic stand protectively in the distance like nannies at a playground. And if all that wasn’t enough, at one end of the beach is a small restaurant/bar where they’ll mix your piña colada right in a coconut and deliver it to your beach chair.

What could go wrong in such an idyllic setting?

We drove from Pueblo de los Pescadores on a Saturday morning along the busy main street in Las Terrenas to the turn-off at the unpaved road to Cosón. It had rained recently and the sandy street had seen better days. Picking our way around potholes, we soon came to the sign for Restaurant Luis pointing down another sandy road lined with palms and palmettos. Past the trees, the first thing to come into view was the crystalline water, and then a handful of cars parked near a wood and corrugated metal hut. We had arrived.

 

After arranging our beach gear on chaises provided by Restaurant Luis, we dove into the sea. We played in the water. searched for sand dollars, and soaked up the sun until our bellies began to growl.

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Restaurant Luis has been on Playa Cosón in Las Terrenas for over 20 years. They prepare some of the freshest seafood and coldest drinks in the area and they do both expertly. Friends in Santo Domingo had recommended a day there more than anything else when they knew we would be in Las Terrenas. As seafood lovers, we couldn’t wait.

My youngest daughter, Haven, and I ordered the dorado fillets, hers fried, mine grilled. Dorado is the local name for dolphin fish or mahi-mahi. Chad and our eldest daughter, Hadley, ordered conch in garlic sauce. We moved from the beach to shaded tables when our food was ready and our plates were delivered, hot and aromatic, right away. We ordered fried plantain and a salad of shredded cabbage, sliced tomatoes and cucumbers tossed in vinaigrette to share. Chad and I washed ours down with icy cold Presidente pilsner and the girls ordered cokes.

They seasoned the seafood simply, allowing the subtle flavor and freshness of the fish and shellfish to shine. Everything was delicious, the perfect accompaniment to a day spent in such a gorgeous setting. As we ate, we made plans to walk down to the beach toward Playa Bonita and scope out the area for snorkeling.

Then, as I took my last bite of dorado, I noticed that the palms of my hands and the soles of my feet had begun itching. Haven said she was feeling the same thing. Within a few minutes our skin had completely flushed, making us look suddenly sunburned but with additional angry red blotches all over. We both broke out in sweat and I started to feel as though I might faint. The fun was over.

We gathered our beach gear and loaded the car quickly. Chad paid the bill hurriedly and we began bouncing down the potholed road back to our vacation rental house in Pueblo de los Pescadores. Along the way, my breathing started to feel somewhat constricted. I looked up a hospital on my iPhone and told Chad where it was, just in case I lost consciousness. Chad and Hadley aren’t prone to panic, but they were seriously concerned about Haven and me.

Talking about hospitals worried Haven more than her symptoms did. She was still flushed and itchy. She said she felt like she had a weight on her chest. She wanted to sleep. We made it home without either of us needing the hospital, both of us feeling slightly better or at least not worse. Haven showered and went to bed.

I also showered, soothing my itchy, red skin somewhat under the cool water, and then I went to sleep. I slept for two hours. I woke up with a headache and a gurgly belly, but the redness and itchiness had disappeared. Haven had already been up for an hour and her symptoms had subsided, but she also had a headache. Only Haven and I experienced any reaction at all and the only thing she and I ate that no one else in the family ate more than a bite of was the dorado.

Looking up symptoms later online, the only thing that came close to describing what I had experienced were in the accounts of ciguatera, a type of poisoning from a microorganism-produced toxin that fish retain in their flesh. Herbivorous reef fish eat algae, coral or seaweed that the microorganism lives on and the toxin ends up in their flesh. The carnivorous fish that eat ciguatoxin-tainted fish then get the toxin in their flesh as well. And it’s cumulative, so that the more tainted fish they eat, the more toxin they store in their flesh. It’s heat resistant, odorless and tasteless, detectable in labs but not in a simple beach-side kitchen. Symptoms can recur with simple triggers, like the smell of bleach, eating chocolate, drinking alcohol, or exercising strenuously. It has been transmitted from one infected person to another through sexual contact and through breast milk. And it’s incurable.

Dorado appeared on some lists of susceptible fish and not others, begging the question whether we were actually served dorado. The practice of passing off one fish for another has become increasingly common, but doesn’t seem likely in a place like Restaurant Luis where you can stand and watch the chef fillet your fish on a table outside the kitchen. Did we get the rare, unlucky ciguatoxin-laced dorado? Could there have been cross-contamination if the chef filleted our dorado on a table where he had just filleted a tainted barracuda or grouper? Or was our reaction caused by something else entirely?

Worried about the long-term implications of what I believed was ciguatera, I called Dr. Laura Sosa at the U.S. Embassy Health Unit in Santo Domingo. She diagnosed it as an allergic reaction. Both Haven and I were missing key symptoms of cigatera, including telltale numbness of the tongue and mouth. It turns out that fish is high in histamine and Haven and I both tend to have histamine-rich diets anyway. The list of histamine-rich foods includes fruit, especially pineapple and dried fruit, fish, eggplant, smoked meat, yogurt, some leafy greens like spinach and arugula, tomatoes, aged cheese, and anything fermented at all, including alcohol and yeast breads. That’s practically an outline of my diet. Looking back at what I had eaten in the 24 hours prior to my allergic reaction, I found a diet awash in histamine-rich foods. I had dried pineapple. I had yogurt. I had beer. I had olives. For dinner the previous evening, I had eaten fresh-baked pizza (fermented dough) topped with cheese (fermented), prosciutto (cured meat), tomato sauce and arugula (histamine rich). My fateful lunch had included fish, beer, tomatoes and vinegar. I was a walking histamine repository.

Dr. Sosa said we would be fine and should avoid histamine-rich foods for a week to let our bodies rest. She recommends avoiding local fish during the summer months. It’s too difficult for the local fishermen to keep them cool enough to be completely safe to eat by the time they reach the table and if they don’t gut the fish immediately, histamine levels rise dramatically. And ciguatera is also a greater concern in the summer.

Dr. Sosa had already advised us to avoid locally caught fish during hurricane season. She had told us during our orientation to the Health Unit when we first arrived in Santo Domingo in March. We received printed materials from the embassy that included the same advice. But when we were there, at that glorious beach, at a restaurant that came highly recommended, and where the seafood sizzling over hot coals smelled so good, we forgot all about the warnings.

There are two lessons for me in this story. First, pay closer attention to the advice of the embassy doctor. It seems ridiculous to eat imported fish in the Dominican Republic, but I’d rather not go through the allergic reaction or worry about ciguatera intoxication again. Second, call the doctor before getting overly worried over a self-diagnosis sourced from the Internet.

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