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Shots, Pills and Overkill: Preparing for an Adventure

“You’ll feel a little pinch,” said my doctor. Great. And me not really liking needles. This was just the beginning of a series of necessary little pinches that have spanned months of my life this past year. One pinch for Hep A & Hep B, one pinch for “the Flu” where I bled all over the place and one really big pinch for – don’t let them fool you about this one – tetanus/diphtheria – with a really big needle.  It hurt.

The medical preparation required to travel to South America need not be that extensive if you are only going for a short while and staying in the cities, but if going to the Amazon basin or farther out into the country there are a lot of vermin to be aware of.  For the Amazon basin and eastern slope of the Andes there is the threat of Yellow Fever and a variety of parasites that I don’t really want to think about.  The there is my favorite pest – the mosquito.  Our friend the mosquito brings us Dengue Fever during the day and Malaria in the evening hours and its least vicious manifestation gives us hours of itching pleasure. 

 A quick review of possible vaccine/immunizations:

  • Hepatitis A & Hepatitis B – Two forms of a disease that affects the liver functions – not fun.  These vaccines are often given as one shot and require a series of three shots at a prescribed interval of 0 days, 1 month, and 6 months to get the most effective vaccine. You really need to plan for this one.  Oh, and Hepatitis A is food born so don’t forget to wash your hands, your food, your hands, your food…you get the picture. You can always just eat prepackaged foods, but then why visit another country?  Live a little. As for Hepatitis B, it’s transmitted through blood exchange – think needles or unprotected sex. 
  • Typhoid Fever – A nasty little contagious infection of the intestines again often transmitted via food.  Remember “Typhoid Mary” the first healthy carrier of the typhoid disease to lots and lots of unsuspecting people?  You can appear healthy but still be a carrier.  We don’t want typhoid.  The alternative is a few pills kept in the refrigerator and taken at the prescribed interval or, yes you guessed it, a shot.  I opted for the pills and I hope to god they worked.  The CDC suggests this little ditty to help you with your food selection: "Boil it, cook it, peel it, or forget it."  You need to get/take the vaccine at least one week before traveling.
  • MMR – Our childhood enemies Measles, Mumps, and Rubella, sort of. While we’ve all heard of these itchy sicknesses I know of no one in my generation that has had any of them.  I guess the childhood vaccines worked.  This shot was my first brush with adult immunizations.  My days at grad school were numbered if I couldn’t prove that I had a MMR booster shot in the past.  Since I couldn’t (my childhood doctor has actually tossed my records) a fresh one was required to fulfill the requirement – they were ready to kick me out.    The shot itself was no problem, but 5 minutes later when trying to just get out of the clinic I broke out into a cold sweat, got tunnel vision and just about passed out in the waiting area.  It was grand.  I got to drink orange juice and have a little lie in. Apparently there is a name for this reaction, but I cannot remember what it is.
  • Tetanus(Lockjaw)/Diphtheria – The “stepped on a rusty nail” or the “you’re going to a developing nation and you can’t remember when your last booster was” shot which is often combined with Diphtheria and sometimes with Pertussis.  The CDC states that tetanus is “A disease of the nervous system caused by bacteria” and I remember it by the descriptive name of “Lockjaw”.  This one hurts like a bitch and is given with a huge needle (even my Dr said she felt bad when she was giving me this shot) and your arm very well may hurt for days. Diphtheria, well, I don’t know much about it, but it seems to be another problem caused by bacteria and is transmitted through body fluids and affects the respiratory tract.
  • Rabies – No one wants to get rabies (and health insurance companies don’t seem to cover pre-exposure rabies vaccines).  It’s the condition that we all heard about as children as we were warned to stay away from the neighborhood dogs and the cute little possum younguns.  The threat of rabid possums foaming at the mouth is enough to convince anyone that this is a very bad condition to be in.  The vaccine consists of three lovely shots that you get at 0 days, 7 days, and 28 days.  These suckers stay with you for a bit – I could feel them in my arm for days but not in a tetanus type way.  While absolutely necessary in the more remote areas of the countries that I will be visiting, these very, very expensive shots really just buy you time and eliminate the need for the rabies immune globulin dose which may be hard to get in some countries..  Instead of going stark raving made within 24 hours you have a couple of days to get to some sort of medical facilities where you will get two or three more prophylaxis shots. No matter what, if bitten or if you touch a questionable animal – wash the wound or contact sight thoroughly with soap and water and get thee to a clinic.
  • Yellow Fever – No problemo getting this one – a small needle – but what a disease.  This viral disease is predominately found in South America and Africa where it has caused epidemics.  In order to avoid an epidemic situation in South America there are strict entry requirements for people coming from countries where the disease is know to be.  You need to get the little yellow immunization card for this vaccine.
  • Influenza – Strains change every year, but in developing countries it’s a good idea to get this one especially if you will be staying in hostels.  When getting this at a clinic or at your company’s annual flu shot day be prepared for a brutally administered shot.  No coddling you here – it’s a swift jab in the arm.  Mine happened to hit a tiny blood vessel and I bled everywhere – so embarrassing.
  • Pneumococcol – Bacterial pneumonia which, according to the CDC, used to be treatable by penicillin.  I didn’t actually feel this shot at all, it was that easy to take.  However, it was the only shot that made me feel a little under the weather.  It’s usually given to the elderly but they suggest it if you will be in hostels or other crowded conditions.
  • Meningococcol – Yet another close quarters shot suggested for hostels or other crowded places.  The CDC list meningococcol disease predominantly manifesting in three forms: meningitis, blood disease or pneumonia and is transmitted by spit.    My LAST shot!

Last but not least, it’s a good idea to get a record of all of your fancy shots placed in the yellow immunization document.  Your regular doctor may not be really aware of this document and if you are going to developing nations for extended periods of time it would be a good idea to stop in at a travel clinic for a consultation as they are the specialists.  The nice travel clinic where I passed over large chunks of cash for those rabies shots, Travel Health Services, knew exactly what was needed.  While this document is not absolutely necessary in areas that do not have Yellow Fever, it is suggested for those traveling overland and in more rural areas.

Even with all this preparation you still have to be careful.  Almost everyone gets at least one bout of travelers’ diarrhea (or so I hear) and you need to try to let the bacteria run its course rather than stop it up with an anti-diarrheal.  Also, to help alleviate the effects of dehydration caused by diarrhea, carry a few electrolyte/salt replacement packets to mix with your bottled water.

Cholera still exists but the vaccine is not available in the US and when used is only about 50% effective anyway.  Dengue Fever, Chagas disease (from little bugs that live in thatch), Malaria and Yellow Fever are all serious disease with no cure.  And then there are the creepy, crawly things in the Amazon and the parasites in almost all fresh water on the continent.  Now doesn’t that suck – you can’t even go swimming without freaking out about taking on a symbiotic lover in you gut or skin.

 Prophylactic medications – those which I really want to have, but hope to never need

  • Altitude meds – The medicine is called Acetazolamide and my perhaps generic version is called Diamox Sequels.  You only need to take this before ascending for two days, while ascending and two days after you arrive at your base altitude.  In my case, 15,000 feet.  A breeze right?  Yeah, I get altitude headaches at 10,000 so this will be interesting.  However, I will be slogging up those 15,000 ft over a minimum four day period hoping that there will at least be some sort of stopping point every 35 miles or so.
  • Malaria meds – There are a lot of choices for Malaria medications depending on the area you’re traveling to, the price you’re willing to pay and which side effect you want to deal with so I’m not going into the details of them all.  The one that I will be using is Doxycycline (generic for Vibramycin). The travel doc gave me this lovely regime and despite the advice from some to not take the pills I think I will. 
    • Wake up and slather on the sunscreen
    • Wait in the tent for 30 minutes so sunscreen can soak in
    • Slather on the 30% DEET – my friend, the mosquitoes enemy
    • Exit the tent into the mosquito laden dawn air
    • Start preparing breakfast – with breakfast take malaria pill.  Of course, I cannot have breakfast until I’ve had my thyroid meds in my tummy for an hour.  The joys of maintenance medicine – and I’m only 37!  With this malaria pill you can absolutely not return to a reclining position.
    • Spray everything you own with Permythrin.  Even the name sounds poisonous.  Ick, but I certainly don’t want malaria.
  • Travelers Diarrhea meds – An apparently unavoidable ailment which should be allowed to “run it’s course” so to speak.  If it’s not getting better and you are becoming dehydrated the initial remedy is a full spectrum antibiotic like Cipro which, by the way, also works for…
  • UTIs – I get them and now with even fewer showers than normal I feel like a time bomb.  Front to back – that’s the key.  Oh yeah, and no sex.  Hmmm, no husband equals no sex – that will work I suppose, but it won’t be nearly as exciting.  I should be good on the UTI front, but this is definitely one problem that I do not want to be missing any meds for.
  • Yeast infection meds – A nice side effect from the malaria meds – do you like how we’re going in circles here?  Me too.
  • Pain killers – Hydrocodone (generic for Vicodin), just in case.  I only have a few and like everything else on the list I hope not to have to use them.  If I crash on a bike it has the potential to be very, very painful and with medical support scarce…what can I say?   I’m a wimp.
  • Motion Sickness meds – Meclizine (generic for Antivert) for the airplanes over the Nazca lines, Lake Titicaca, and  those pesky ferries down south and – the only way to continue on your way sometimes.
  • A world of ibuprofen or Aleve – those general aches and pains and headaches.  This is one pill that I will be taking fairly frequently. 

And then there’s the First Aid Kit.  I don’t think that I have the patience to list everything in here, but I did pick the one that gives me my very own needles!  How exciting.  After all that explanation about disliking needles here I am buying my very own.  This precaution seems like overkill, but may be important.  The rural medical facilities, from what I’ve heard tell, are not the most up-to-date and may be severely lacking in supplies such as uncontaminated blood and clean needles.  So if I get bit by a rabid dog or somehow a mosquito slips through my defenses I will have needles on hand to get the shots needed.  Overkill, but I have no idea what to really expect but have heard so many different stories, some firsthand, that I might as well be prepared.  In addition to the main first aid kit I added a Sam Splint, a blister packet, and an emergency dental filling kit. 

 Water purification –

Filters, boiling, carbonated bottles, chemical cleansing, let’s just say you’re supposed to do all of them.  Filtering is not enough.  Filtering and then boiling is not enough especially at altitude and who has enough fuel to boil allll that water anyway.  The smell of diesel or unleaded gas in the morning will put me off my feed if anything will, especially diesel.  The best bet will be bottled water and filtered/chemically treated water.  Products that I will be trying include Micropur MP1 tablets and Pristine water treatment chemicals.  One is easy the other is cheaper.  A filter tip from Mr. Everett Briggs, world cyclist extraordinaire, do not filter water directly from moving streams in the Andes because the fine, invisible glacial silt being carried in that seemingly good water source will kill you filter in one or two uses rendering it useless.  It is better to have a “dirty water” container where you can collect water, let the sediment settle and filter into a “clean water” container.  Thank you Mr. Briggs.

 The Sun – It’s strong.  Use sunscreen and lots of it.  Labiosan is great for high altitude protection of the nose and lips.

 The Altitude – Altitude sickness is a very serious illness that can affect anyone – physically fit or not.  It is important to ascend to altitude slowly so that your body can acclimate. And if that isn’t possible then you need to take the first few days at altitude very slowly.  Walk slowly, eat, rest.  The meds help a little (carbonated beverages feel non-carbonated!) but listen to your body.  The repercussions can be fatal.

 And last but not least, my favorite thing of all…food.  So many rules, so many things to try: cui, ceviche, lamb, llama, and oh the potatoes,

Food –

  • Rule #1 - No salads.
  • Rule #2 – Everything needs to be fully cooked.  This will be hard in Peru – home of ceviche – which I’m determined to eat parasites be damned.  And not to mention Argentina – land of steak and lamb where I’m hoping that a few months of riding will, by that point, have my system ship shape and ready to deal with some nice red meat. 
  • Rule #3 – Only eat fruits that you can peel yourself. Sanitize the fruit, sanitize you hands, peel the fruit, EAT.
  • Rule #4 – Don’t eat the seafood obtained from some scary guy off a dock in Chile – Red Tide is a problem and is deadly.  I’m going to trust that the restaurants buy from reliable sources and am looking forward to a bowl of caldillo (a rich fish soup).

 I’ve run out of steam.

Comments

Hi,
It's coming together now! I've copied your information for Dad.
Love,
Mom

Hey- this is pretty amazing. It's coming up! Let me know if you need additional funding and/or specific equipment. No promises but I'll see what I can do.

Wow!!! only a month? Time flies!!
I have only one rule for food: If other people are eating it then so can I. Well I was born in a 3rd world country so that helps a little...

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