Medical Interlude

I'm taking a break from (ir)regular travel updates to write about the most significant medical impacts on our trip so far, and that's not even including having my front tooth fall out about an hour into Wang Daeng Cave in Phitsanulok!

First, there's our efforts to avoid malaria, which caused problems of their own, then there's the knee infection I got, which required minor surgery. Fortunately, I'm writing this well after the resolution of all of this and I can report from the future that everything turned out okay and we're still fine. But for a while - with both situations - we weren't so happy with how things were turning out.

Doxycycline

First up is malaria prevention. Before the trip, we'd investigated several anti-malarial medications. Doxycycline, Mefloquine, Malarone and Chloroquine. Each had certain drawbacks: Doxycycline can cause an upset stomach and sun sensitivity (i.e., easy sunburning); Mefloquine use was discontinued by the US Army because it causes psychotic hallucinations and disturbing dreams; Malarone is relatively symptom-free, but very expensive and Chloroquine doesn't work in Southeast Asia for reasons of drug resistance. We ended up selecting Doxycycline for our period of longest exposure in Thailand, which meant we'd be taking daily pills for about five weeks. During those weeks, we were fortunate not to experience the sensitivity to sun, but boy were we slammed with stomach problems and we spent a lot of time experimenting with different ways to take the pills to relieve these symptoms as much as possible.

We were advised to take the pills on an empty stomach (no food for two hours before or one hour after taking the pill), which made planning mealtimes difficult. We were also advised to take the Doxycycline with plenty of water, and that's probably what ended up hurting us the most. I'm not accustomed to drinking much water first thing in the morning, but when we started, that's what we did. For a while we woke up, took our pills with a half liter of water each, waited an hour and then had breakfast. Under that routine, I spent the first half of each day feeling really queasy and unwell, and Ryan had stomach cramps for hours. Eventually, with some experimentation, we revised our routine and began taking the pills after breakfast, and with sweetened tea instead of water, which helped immensely. Even still, we felt stomach-sick every three days or so until about a week after we discontinued the Doxy. Boy, was I ecstatic to be done with Doxycycline!

Okay, I don't like talking about stomach troubles much, but I thought it might be helpful to anyone else about to embark on a similar adventure with Doxycycline. Of less use to anyone else is what happened to my knee, but perhaps the personal drama is interesting nonetheless.

Carbunculosis

Somehow in Ayuttaya I managed to get a small bite or scratch on my knee. It got a tiny infection, and for whatever reason, the wound closed up over the infection, trapping it inside. Then it grew, got worse, and eventually impaired my ability to walk. I noticed the bump when it was tiny. There was a red spot with a white pimple in the center on the top of my left kneecap. I ignored it, perhaps I scratched at it, but it was nothing.

The next day, it had grown into a small swollen lump. It was tender to the touch, and sometimes it stung when my knee flexed all the way, but I pretty much ignored it more. I might have mentioned to Ryan that it was hurting a little, but there wasn't much we could do. We got on the train and went to Bangkok.

By the time we arrived and had to walk to our hotel in Bangkok, my knee was hurting a lot. The bump had swelled up until I had a second kneecap on my first kneecap. I couldn't flex my knee at all without some pretty severe pain and I decided I should probably stop by a hospital and see what was what. Fortunately, there was a very nice hospital a couple blocks from the hotel. BNH Hospital specializes in ex-pat care and has been around for about 100 years, so that was a stroke of good fortune.

The doctor I saw there told me I had should have surgery: the wound should be cut open, the dead tissue removed, and the infection cleaned. I didn't like the sound of that, and there would be a long recovery process during which I couldn't go swimming. That would mess up our caving and beach plans, so I asked about an alternative option. Maybe I could just take some antibiotics and hope it cleared up on its own, he suggested. I thought that sounded better, so that's what I did.

Despite the antibiotics my knee didn't get better. It continued to hurt, and so a couple days later I went back in and this time agreed to the surgery. It hurt like __________(expletive, indicating a painful noun). I got about a dozen injections of local anesthesia, and then there was a scalpel, a lot of cutting and scraping, poking, prying, sharp metallic tweezers, bottles of fluid, gauze pads and at last some smelling salts to revive me from my inevitable wooziness.

Even after all that, my knee still hurt (a hole in your knee might hurt, you should assume), and while walkinghobbling around at the weekend markets I picked up a Burmese military cane (a souvenir item here that proved functional enough for my needs). You can see the cane in the photos at the Lopburi monkey festival. The monkeys there loved the cane and climbed up and down it, especially when there were peanuts or other treats involved.

Monkeys on a cane!

I had to go back into the hospital for daily cleanings, which meant more prying, prodding, tweezers directly into the incision (OUCH!), gauze pads stuffed under my skin, soaked with antiseptic juices. We had to change our plans to accommodate the doctor's orders. We stayed a week longer in Bangkok than we'd intended. We skipped several days of beach (Ryan went swimming one day in an ocean water park while I stayed on the sand and chatted with the local Thais running the park) and had to abandon some of our cave plans that involved water. My knee is healed now, but I've got a ridiculous scar now that does all the fancy things scars do, like pucker up in the cold or turn colors. Whee. Don't get one, I say.

Bonus anecdotes

Just for honorable mentions, I'll talk about the tooth I teased you with, and Malarone, which we took in Argentina (yes, we're that far behind in the blog!) My crown came off after lunch in Tham Wang Daen in Phitsanulok. I carried it back to town and visited a mor-fan (dentist, literally "doctor-tooth"). For 300฿ (US$10) he glued it back in place. Since it's still there now, I suppose that turned out okay.

As for the Malarone, it's expensive, sure, but it had none of the problems we had with Doxycycline. First of all, we only had to take it for 1 week after exposure, not 1 month. Second, it's taken with food, not on an empty stomach. It's too bad that it's so expensive, because it seems by far to be the better experience, and I'm happy to report that we didn't get malaria while on either drug. Of course, the risks were fairly low in both cases, so maybe we never really had to test the medicine's effectiveness, but that's the way it is with preventatives. They feel like a waste when nothing happens, and they're definitely a waste when something happens, because it's not supposed to.