A New Zealand woman has spent more than 30 weeks in hospital and cannot eat properly after she was poisoned while eating fish during a dream holiday in Fiji.
Amanda Austrin has a severe case of ciguatera poisoning - a rare illness with no cure or antidote - after eating the fish with friends in July last year.
The odourless and tasteless toxin, found in predator fish in tropical and sub-tropical waters, can cause vomiting, diarrhoea, cramps, weakness, reversal of the normal sense of hot and cold, high blood pressure, paralysis, and in rare cases coma and death.
Most sufferers get over their illness within weeks or even a few days but Ms Austrin is among the very rare cases in which symptoms have lasted more than a year.
The Whakatane 41-year-old suffers from hot and cold reversals, meaning her shower temperature has to be very hot to provide any comfort for her when she bathes.
She still vomits every day - 18 months after her Fiji visit - and now has an extensive list of foods she cannot eat via a machine that feeds her for several hours of every day.
She wants to warn those considering holidays in the tropics to take caution when eating fish.
"Just don't eat it," she said. "There were no warnings whatsoever in Fiji from the restaurants dishing up the daily catches or from the locals.
"I imagine if you went up to the chefs and asked if the fish was ciguatera-free, they're not going to admit to it because they would lose too much business."
More than 100,000 Kiwis travel to Fiiji each year.
Ms Austrin, who has shed 20kg in weight, said the Ministry of Foreign Affairs and Trade (Mfat) and travel agents needed to warn people heading for holidays in tropical areas to be wary of ciguatera poisoning.
"If I could have, I would have sued my travel agent. I have friends who went to Rarotonga today and there is no way they are going to be eating fish and that's because of me."
Robin Slaughter of the National Poisons Centre in Dunedin said a 2010 article in the New Zealand Medical Journal noted an increasing number of travellers returning home with the symptoms, which many local doctors may not be familiar with.
The New Zealand Doctor magazine said that in major endemic areas, including Australia, the Caribbean and the South Pacific islands, the incidence of ciguatera poisoning is about 50,000 cases a year.
A report by the Institute of Environmental Science and Research, Foodborne disease in New Zealand, showed just two cases of ciguatera poisoning last year and no more than two outbreaks in any of the previous nine years.
But a 2007 NZ Food Safety Authority report said many travellers might not even know they had the illness and poisoning was likely to be unreported by a factor of 10 to 50.
Ms Austrin has spent more than half a year in hospitals but said because the illness was not commonly known in New Zealand, doctors were battling to deal with it.
"Every doctor I had had to Google it to find out how to do treatment. I'm the first case they have come across. That is why I want to get it out there.
"There is nothing they can do for the toxin. All they can do is treat the symptoms."
Ms Austrin is due to be admitted to Waikato Hospital soon for a neurological assessment.
She plans to marry her fiance on their Whakatane farm next month.