Preparations for the trip

Let’s talk about drugs.

Specifically, let’s talk about all of the immunizations and other medicines that I have, or will, take for this trip of mine. A few months before my trip, I made and appointment to go get my various immunizations from Dr. Hennigan’s office in Fayetteville. His office consists of a few doctors that are internal medicine and infectious diseases experts. I’ve really tried to live a life that wouldn’t get me into this particular waiting room.

When I got there, they had me fill out the doctor’s paperwork you fill out on any normal visit, with the exception that you were supposed to list of all the countries you were planning on visiting. Considering I’d estimated that I am going to go to about 40 or so, there wasn’t exactly room enough on the form to list them, so I just put down the general locations (e.g. Central America, west side of South America, south and east Africa, etc.).

I was shortly escorted to an examination room. My doctor came in with my paperwork and sat down. Doctor Lisa looked down at my forms, got the part outlining the countries I was going to on the trip and got quite visibly excited.

“Are you going around the world?” she asked.
“Yep,” I replied.
“How long are you going to be gone?”
“About a year or so.”
“Do you have it all planned out? Do you know all the places you are going to go and when?”
“I’m going to try to go around without getting on a plane or making any advance reservations. So, I’ve got a general idea of when and where, but I don’t precisely know. Pretty much what I put on the form is my plan, in general.”

She almost jumped out of her chair and said, “this is so exciting. I think you may be going to more places than anyone I’ve ever treated. Hold on, let me go get some maps.”

I don’t think I’ve ever had a doctor get enthused about treating me before this particular visit.

She came back with a stack of color-coded maps of various countries that might be on my route. The maps showed areas where certain immunizations or other medicines were recommended. They were quite detailed and she started going over specific countries and asked me the chances I’d be in such and such part of the country. Since I don’t have a specific plan, I couldn’t give her the detailed answers that she was looking for. I really have no idea if I’m going to be going to northeast Honduras, for instance. She settled for me throwing out a “very likely, possible, or not likely” reply to each area on her map that indicated some version of possible trouble. She also gave me some handouts on some of the various diseases I might be exposed to, explaining the symptoms, treatments, immunization possibilies and so on.

Here are some of the highlights: “Tetanus, Diphtheria, Pertusis (Tdap) – Tetanus (Lockjaw) causes painful tightening of the muscles, usually all over the body. It can lead to ‘locking’ of the jaw so the victim cannot open his mouth or swallow. Tetanus leads to death in up to 2 cases out of 10. Diphtheria causes a thick covering in the back of the throat. It can lead to breathing problems, paralysis, heart failure, and even death. Pertussis (Whooping Cough) causes severe coughing spells, vomiting, and disturbed sleep. It can lead to weight loss, incontinence, rib fractures, and passing out from violent coughing. . .”

Sold! Give me that immunization, please.

I also got the Hepatitis A vaccine. I’d already gotten the three shot treatment for Hepatitis B a few years back when I was the Public Defender for our local Drug Court, so I didn’t need that one. The Typhoid vaccine also sounded like a good idea (“if untreated, it can kill up to 30% of people that get it.”).

The Typhoid vaccine was an oral vaccine that I had to take on an empty stomach every other day three times – take it, day off, take it, day off, take it. Dr. Lisa recommend I take it at the end of the day each time and also said it was recommended that I was alcohol-free on the days I took it. It took me about a month to find the time to work that into my schedule.

Then she pulled out a map of Africa and showed me the areas where I might contract Meningococcal disease (meningitis). It can come in a few different forms, but it is basically an infection of the brain and spinal cord. She said, “it doesn’t look like you are going to hardly any of these countries, but why don’t you read up on it and see if you want the vaccine, while I go get the malaria maps. It’s sort of an expensive vaccine, but it’s your call.”

Handout: “About 2,600 people get meningococcal disease each year in the U.S. 10-15% die, in spite of treatment with antibiotics. Of those that live, another 11-19% lose their arms or legs, become deaf, have problems with their nervous systems, become mentally retarded, or suffer seizures or strokes.”

Those are the statistics if you get it in the United States. And are treated for it.

Yea – I think I can pony up the $180 for that vaccine. Hell – if I’d read this pamphlet and I wasn’t planning on the leaving the U.S., I think I’d have insisted on getting the shot anyway.

Yellow Fever vaccine (“can cause: fever, jaundice, liver or kidney failure, vomited blood, death). Check.

Some of the maps she was giving me had titles that I wasn’t too enthralled with either. Take the Yellow Fever map of Africa for instance, which was titled, “Map 4-15: Yellow fever-endemic zones in Africa, 2007.”

Endemic is just not a word I am very fond of, at least when it comes to describing infectious diseases.

She then pulled out all of her malaria maps. Basically, I have to take a weekly pill when I’m in the malaria zones, which apparently includes my entire trip except for parts of the Middle East and also Australia and New Zealand. What I didn’t know was that there were different types of pills you had to take, depending on where you were. Luckily given my route, I’d only have to change types once. I’ll be taking one type of pill in Central America, South America, and Africa. Then taking another for Southeast Asia (and India, if I go there).

She also prescribed me a couple Z-packs, in case I got some bug on the road that could get knocked out with those antibodies. And she wrote a prescription for some anti-diarrheal medication.

All in all, between the doctor’s visit, the vaccines, and the other medications that I got at the pharmacy, I think I blew about $700 or so.

Best money I’ve spent in a long, long time.