I do try to count my many blessings, and reasonably good health, plus access to advanced healthcare are right up there at the top of the list, in my view.
I have been lucky to travel to many exotic destinations, and... generally... lucky with my health, even in places where many tourists fall ill, and many locals suffer dreadful diseases not endemic in the US or UK. And the story of what healthcare is available to whom is worthy of a website of its own.
And so it was on this trip. On this trip. It is, I think quite a funny story, which you can read if you wish, below the picture I'm just coming to. It shows the track on the front of my left shin of a "little friend" I brought home with me... and which led, in part, to two visits to the splendid Hospital for Tropical Diseases, in London- an exciting outing in its own right. They (HTD) were superb! And my little friend, a nematode larva (hookworm), was subjected to some poison... just one dose of medicine (oral), and my "cutaneous larva migrans" should be all over. And it never presented any serious risk to me... but full marks to the nurse at my doctor's office for noticing the "something not quite right". (More on that in the "full story" for those who embark upon it... after photo.)
And so to the full, "funny" story... which is all that remains on this page. Abandon it as soon as boredom threatens...
I was fine, on my trip. Hurrah. I even managed well below my usual quota of insect bites, especially around my ankles, where I usually provide a major chigger feast, and end up with very frustrating itches. Partly season, partly care to keep trousers stuffed in socks and treated with repellent. (One of the delights of living in England is the absence of biting insects. They are a downside of my New England summers!)
On return I felt a little "fluey". And either on the last day in Africa, or first day back, got what I believed to be a spider bite on my ankle. I get these a few times a year; they generally follow a predicable pattern, but don't usually include the fluey-ness. That, which I didn't associate with the bite, included minor aches and nausea, and some annoying episodes of night and morning "sweats"... soggy sheets and bed... sigh. Slight chills, slight fevers. Yes, I'd taken my malaria medicine properly, but it isn't, sorry to tell you, 100% protection.
Well, infection around the "spider bite" spread more than is usual, and was getting worrisome. Friday, 2 March, I finally gave up waiting for it to "turn", and went to see doctor. Well, nurse, actually, no doctor being available. While looking at the bite, the nurse noticed the lesion photographed above, which I had not noticed... it was a bit itchy, but so was much of the area around the infection. When pointed out to me, it still didn't look significant... just a bit of inflamed vein? The infection had spread a bit. She didn't think it looked right, asked doctor to check. And that's when I was told, "between this and the chills/ sweats, why not go up to the Hospital for Tropical Disease, in London?". That was a bit frustrating, as I had just been up there on a big book buying expedition, but of course I wasn't going to just ignore the doctor's advice. And the visit to "Billy" in connection with the book buying had been (just a little!) disappointing, as the boy dancing that night no longer has a treble voice, and one or two "big numbers" didn't come up to the usual standard... although the boy concerned does the "acting" part of the role better than many, and is one of the better dancers I've seen. Sorry... back to the medical saga/ funny story.
The Hospital for Tropical Diseases is an amazing place! And they offer an amazing service: Travelers who have returned from the tropics and are unwell, with fever or bloody diarrhoea, can attend the walk-in emergency clinic at the Hospital without an appointment!
My fever was slight, but a doctor had told me I should go up for the "emergency" clinic, and I wasn't going to jib. And there was not hint of "what are you doing here?" at any time. Quite the opposite!
As my visit was to be as an outpatient, just a case of "show up, await my turn", I decided to go up Monday afternoon, spend night, be there bright and early, at start of Tuesday's queues. This worked well.
(Of course, seeing Billy again the previous evening didn't detract from the overall package! (And, thank heavens, "won" the "roll of the dice", and saw a different boy Monday... with a treble voice... and the wonderful Ann Emery, back in the show as "Grandma".... hadn't seen her since a period of time when she was away. Oops! Back to the story...)
Had fun Monday afternoon, visiting a shop selling antique maps, and the Science Museum.
Here we come to one of the "funny" parts: By now, the infection in the bite was beginning to go down... at last. Had it "turned" just a little earlier, I wouldn't have seen nurse, and the CLM wouldn't have been noticed, the recommendation to visit HTD wouldn't have arisen! 'Flu symptoms were abating, too, by this time. I truly "hadn't been myself", more than just the usual post- long- flight malaise... but nothing too awful, either.
Going back and forth between the US and the UK makes me particularly aware of the debates over models of healthcare funding. I pay high taxes in the UK, and in some areas, the UK's National Health Service struggles... as does the US's. It is interesting to see where each excels.
I had a great half day at HTD... wonderful staff. Very professional, friendly, thorough, etc. Malaria ruled out. Everyone visiting is offered an HIV screen, and while I've no "risk factors", other than having had transfusions, and done a little first aid work here and there, it is still nice to know I am HIV clear. Chest X-Ray. Several blood tests initiated. Doctor complimented me on my weight... in her line of work, a little padding is "good"... nice change from the sometimes emaciated people she sees! (And a nice change from the comment at my last flight physical that I could lose 20 pounds to my advantage. I still cling to the idea that I am not over weight!)
The little red track on my leg confirmed as "not right", and identified as CLM... which, happily, is trivial, would probably have run its course without adverse affect... but just to speed things along, I took one dose of pills, which killed my "little friend". (The itchiness sometimes leads to scratching, which can lead to infections. That's the worst case.) The parasite apparently lacks an enzyme that others have, and it is unable to burrow below more than very superficial layers of human skin! Poor little guy! More clever beasties have a collagenase which allows penetration of the epidermal basement membrane. (Thank you, Wikipedia.)
How did I get it? Just one of those things, evidently. The larvae inhabit the tissues of cats and dogs (and other mammals?) for part of their life cycle, and the soil at other times... so presumably, I got a little dirt on my shin at some point.
Just before I go on to the next part of the story...
For most citizens of the world, it would not have been possible to have a doctor look at the worm track or consider the flu or order the many tests I had...
But! Thanks to the HTD and the NHS, I had access to all of that without a wait, and nothing more to pay, beyond taxes I'd already paid! Not only a doctor... two, counting the one in Chichester, who sent me up to London, but a specialist in tropical disease! Now... don't let that come across as a belief that the National Health is "the answer"... but it certainly gets some things right!
So... started with a bite which I might not even have got in Africa. It got infected to the point I decided it was time to see doctor... but that went down of its own accord. But by then, CLM and 'flu symptoms had me off to London. CLM no big deal, no malaria, and 'flu also cleared up by itself... but... perhaps a big but...
Up at HTD, as part of early assessment, a "routine" blood pressure test... and everyone quite unhappy about my levels, then, and on two re-tests. If I'd been having headaches too, I believe they said I would have been put in a bed, treatment started up there... but maybe I misunderstood their thoughts on this, or maybe they don't do a lot of blood pressure management. I was to see my doctor that day, upon return to Chichester. Sigh. But good to have it caught! (For some time, when I've had blood pressure checks, the reaction has been, "Hmmm, a little high... ")
Chichester doctor didn't have an appointment available. Nurse re-took pressure, and set me up for a monitor and an appointment in the next week. As I don't smoke, and hardly drink, no room to make changes there... good, I suppose... but the dread "exercise" and "diet" issues have come up. Sigh. Beats the alternatives, though... (London also did a urine test... kidneys a little unhappy.)
What a strange route to the discovery of the need for attention to this! Hope you are enjoying the story... thank you for pressing on, reading to here, if only "just in case" story got better. Funny in its way? You can stop here, or read on. There's more!
The blood pressure monitor "thing" appealed to my geek side: For 24 hours, I wore a typical pressure cuff, and a tube under my shirt down to a small device on my belt. It automatically inflated the cuff, took readings, recorded them from time to time. Took it off, handed in to doctor's office, after the 24 hour monitoring.
The following week I went in for the appointment... and doctor was a little perplexed: She didn't have the results. There'd been some glitch. So we talked a bit, but a new appointment was scheduled. I'd taken some readings of my own, and they pretty much agreed with the monitor. (It displayed its readings, a few times.) Doctor said that unless the full monitoring results threw up some surprises, I'd be seeing what "lifestyle changes" could do over a few months before any medication would be brought to bear. So... we're in the midst of one of those "who do you believe" things, but I also understand how legitimately difficult it is for medical professionals to "disagree" with another professional, so I "can't" approach the London doctor, ask her if I should press the Chichester doctor. Sigh. And here's another aspect of the National Health: Good at a "crisis", not so good at responding to chronic things.
But! It doesn't end there!
First another "funny" part:
The night I got back from my first visit to the Hospital for Tropical Diseases, I had a message on my answering machine from my local doctor's office: "There's a prescription waiting for you at Boots". ("Boots" being the name of a chain of "chemists"/"pharmacies", (English and American, respectively))
What prescription? I hadn't seen the Chichester doctor, and in London I'd been given the antihelminthic.
(Digression to count a another blessing: Getting the medication... for which I paid nothing more than the already paid taxes... was a simple matter of going to another at the Hospital for Tropical Diseases, handing in a slip, and waiting maybe 15 minutes.)
So, next morning, went into town, went to Boots, asked for my prescription. They knew nothing. "Maybe our other branch? Your doctor does use us and them." The branch I was in tried to call the other branch on the phone for me, but couldn't get through. Now... if you are a doctor's office, frequently telling people to pick up medicines, and you use two branches of a chemist, don't you think you would have learned that people need to know which branch? Sigh.
Traipsed up to other branch. No, they knew nothing, either. But they phoned doctor's office, prescription faxed through. A two week course of doxycycline, an antibiotic. Ah! I guessed the doctor in London had arranged, to "finish off" the infection which was on the way out, but had been a little tiresome. Happy! And, it turned out, that this time (I've had doxycycline before) the drug hasn't left me with a nasty taste in my mouth for the duration. Good!
And then, again unexpected, a letter arrived telling me that an appointment had been set up for me to see a Professor at the Hospital for Tropical Diseases. The blood tests had come back with indications of something. An earlier phone call had already told me that, and told me there wasn't a problem. I'd thought we were done... but (cutting out a bit of the story), back to London on the 20th, overnight, for early appointment on 21st. More fun times as I was in town anyway. Visited museum of the Foundling Hospital for the first time. Very interesting. Expanded my understanding of those serious issues. Handel connection interesting in general, and to me in particular, as he is the composer "imprinted" on me. Also British Library... Codex Sinaiticus... much more beautiful that Wikipedia image would suggest... amazingly clean and "modern"... looks like something from the art deco period. Also (British Library) superb exhibition on book conservation... do seek it out next time you are there. Permanent, but not easy to find! British Library. Billy in evening... There's a surprise. New boy dancing the part... one who in real life lost his mother three years ago. As the fact that Billy's mother died when he was young comes into the story in several places, it makes for some interesting reactions as you watch the play, if you know the actor's circumstances.
Anyway... back to medical story... Good session with doctor. Got more details of what blood test had shown: I'd had a touch of a rickettsial disease... probably south African tick typhus. No big deal. A bacterial infection, from (probably) a tick bite. Similar to Lyme disease, Rocky Mountain spotted fever. Already being dealt with by the doxycycline. Which would also be "the answer" if I had Lyme disease instead, from my Connecticut life. As I said: Yes, I had something... something that "they" have "an answer" to, and which doesn't leave "scars"....
But!.... (How long is this piece of string???).... in the paperwork preparing the way for the appointment with Dr Mabey was a request that I bring a stool sample. So! MORE tests! Which I welcome! Can't have too many tests! Among others, tests for something I may have had since a trip to the Amazon. It hasn't been a major problem, obviously, but if I have it, it would be nice to stop having it! And a test for schistosomiasis (aka bilharzia). Do you know how significant that is, from a global perspective? Everyone knows about malaria, as they should, and thank you Gates Foundation for your good work. But schistosomiasis is almost in the same league. No big deal, if I have it. But hugely important in areas where people's general health isn't as good. And if I do have it... not impossible... then getting rid of it all to the good.
Two things: The tests are back... all negative. Good! But not, I hope, Gentle Reader, you agree, a waste of time/ money? (The last time I went in for something like this it was in the US, and I paid for my tests myself!)
And when I finally saw a doctor (a different doctor, as it turned out) to discuss my 24 hour blood pressure readings (which I still haven't managed to obtain a copy of, despite the doctor, and me, separately, asking for a copy for me), the "discussion" was minimal (perhaps it was thought that I'd discussed the issues with the previous doctor)... but I was put on a "maximum" dose of a calcium blocker. Will watch and see! (And exercise. And change diet. Sigh.)
So! That's the story! Hope it wasn't just a boring saga. Hope the aspects which amused me were amusing to you!
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