an account of my health over the trip (original version was written to seek advice from my travel doctor)
18.02.2012 - 26.04.2012 79 °F
Febuary 18: Baños, Ecuador, diagnosis myself with parasites due to following symptoms: fatigue (energy one day but not the next), joint aches, easily blistered skin, consistent gas, occasional and small amounts of blood in stool. Our WWOOFing host, an aging Canadian ex-schoolteacher/hippy explained to me how she had been experiencing the 'sulfur burbs' and was afraid she had parasites. She pulled out the pills she said she takes at least every six months 'just to be sure', and for $2.80 it seemed to make sense.
Take Parasi-kit: 2/18 evening, 1 tablet albendazol 400 mg.
2/19 evening, 2 (1 g each) tablets secnidazol
I feel substantially better over the next couple weeks, higher energy levels, better digestion, less gas, less aches. No more parasites!
March 8: Puerto Lopez, Ecuador. On the bus to this coastal town I feel like I am fighting a sickness. The following evening I go to bed early with swollen lymph nodes and exhaustion. My lymph nodes return to normal but my energy level remains low the following two days in Puerto Lopez. Amy and I prepare delicious fresh fish (cooked!) meals at the hostal including beet salad. My urine is red.
March 12: Cuenca, Ecuador. Severe and consistent fatigue though little other symptoms finally prompt me to consult a doctor. After hearing Amy's translation of my past months health and self-prescribed parasite medication, the friendly doctor has a quick listen to my stomach and intestines and declares I have a bacterial infection. She writes a prescription for antibiotics as well as pain and bloating medication (neither of which I really suffer from) and almost as an afterthought tells me to go across the hall to get my stool tested. After successfully obtaining a stool sample with the miniature spoon and dish purchased for $0.07 I wait fifteen minutes for the results. Amy convinced the lab worker to test for parasites as well as bacteria ($4 for the former, $1 for the latter). The doctor emerges from the lab and exclaims “muchas amoebas!” were found in my stool as well as bacteria. She scribbles another prescription for Flagyl that I am instructed to take following my antibiotic regimen and we ask her how these intruders may have found their way into my digestive tract. “Comida del calle” (street food). She thinks I have probably had them for many weeks and not parasites but the steroids in the Parasi-Kit made me feel better for a little while. We happily pay her the $5 consultation fee and are on our way. I feel a little squeamish at the thought of all the things living inside me at the moment but am relieved I have gotten a diagnosis and prescriptions for treatment. I hypothesize that I ingested an amoeba cyst more than a month prior, after cleaning out pig pens in San Agustin, Colombia or while eating the double servings of blood sausage served at every meal there (Amy gave me hers). Impossible to know, bacteria or amoebas could have been contracted from any number of grilled street meats, unwashed or washed with contaminated water fruits or vegetables, juices made from unpurified water or chilled with unpurified ice, or any other food or less than purely hygenic situation we have been confronted with but embraced in the spirit of traveling.
March 13-March 18: 1 tablet Bactiflox 500mg every 12 hours, morning and night for five days.
March 20-27: 1 tablet Flagyl 500 after lunch and dinner, 2 pills a day for seven days.
I feel much better just a couple days after starting the antibiotics. My energy returns and the trip goes on into Peru. After finishing off all the medicines I still have some indigestion (perhaps because much of my beneficial digestive bacteria has been eradicated) but also some slightly sulfurous or stomach bile tasting burps and I worry that there are still some things going on in there that shouldn't be.
March 31, outside Tarapoto, Peru. We are now in the fringe of the Amazon river basin and jungle and contemplate beginning to take our Malarone for malaria but hold off after talking to our volunteer hosts who say there has not been any malaria in the area. They say some dengue has been reported in Tarapoto but none in this small town 40 minutes down a dirt road. I am quite sore and tired after building steps in the mornings and playing soccer with the locals in the afternoon. My body doesn't seem to recharge or rejuvenate as I would like despite the thoroughly enjoyable bathing and swimming in the river every afternoon. As has been the case throughout the trip it is so hard to tell what is normal work, play, and travel wear and tear and what are symptoms of something else...
April 6, arrive in Yurimaguas, Peru on the river Maranon, tributary to the Amazon. Amy and begin taking Malarone, one pill at sundown each day to keep the malaria mosquitoes at bay.
April 7, we depart Yurimaguas on a large passenger boat/barge heading down river to Iquitos. I have some diarrhea and compulsively I decide to take the recommended three day regiment of Ciproflaxin (1 500mg pill morning and night) somewhat preemptively as I have read many people contract forms of dysentery on this trip. Probably totally unnecessary and not the best idea in hindsight, but I have the medicine with me and down it goes to ease my bowels and my mind so I can get back to relaxing in my hammock berth and watch the river bank go by.
April 9, arrive in Iquitos, Peru on the Amazon river, the world's largest city unreachable by road (over half a million inhabitants). End self-prescribed Cipro medication, feel good.
April 10, Iquitos, Peru. Following a delicious palm heart salad dinner and the best chicken I have ever tasted I enter the bathroom of the rotisserie chicken diner. After what seems to be a little diarrhea I wipe only blood. Many pieces of red toilet paper later I am finally clean and very worried. I wonder if a fish bone from lunch at the market earlier has punctured my insides or what else could possibly be causing so much blood. Amy asks our waiter where the nearest clinic is, we pay the bill, and hop in one of the thousands of rickshaw taxis racing around the city. I don't feel bad but I don't want to mess around when there is blood coming out of me. Amy has to do all the talking as usual at the clinic and tries to relate my health history over the past 6 weeks and explain the current situation. The doctor thinks the blood was probably full of dead amoebas being expelled from my system. He asks for me to poop in a cup but after extended effort I cannot produce anything. No blood, no feces, shit. I take the cup with me and promise to return before their overnight shift ends to avoid paying another consultation fee with a new doctor (65 soles or about $25). After four hours of sleep we return, I perform in the bathroom, and we deliver the specimen to the lab. Two hours later we receive the results: everything normal, no blood, but under 'celulas de almidon' the test finds 'escasos' which we understand to mean cell casings or probably dead amoebas. The test also finds Blastocystis hominis, a parasite. After these results the doctor prescribed me Colufan (I believe, difficult to read doctor's handwriting...) for the parasites but the pharmacies only had Noxzolin 500mg (Nitazoxanida) which I was assured was the same thing. I was also prescribed Bactim Forte, an antibiotic.
April 11- April 13: Noxzolin 6 tablets morning and night, every 12 hours for 3 days.
April 11- April 15: Bactim Forte 10 tablets, every 12 hours, morning and night, for 5 days.
During this period, from March 12th to the 14th we went on an eco-jungle tour where we slept in tents, went on hikes through the jungle and waded through multiple flooded trails, one in which we had to swim. We saw only two snakes and didn't find any leaches on each other but who knows what other organisms lurked in those murky waters. I stopped taking my Malarone after I began taking these other medications and hearing from our guide (who had contracted malaria multiple times and whose wife was a malaria researcher, actually they met when he was her patient!) that there was no malaria or dengue in the area currently. It was probably unrealistic, but I felt protected against contracting more parasites in the jungle since I was already on medication for them!
Apart from a few insect bites I returned from the jungle unscathed and feeling fine. We flew to Lima, Peru on April 17th and that afternoon my temperature began rising, accompanied by body aches and a headache. I had a fever through the night, maximum measured temperature of 100.1 (my normal temperature is usually around 97) but my temperature was back to normal by the morning and I began to feel better. I had my feces tested again in the lab which I had been planning on before the fever and waited for results before consulting a doctor. That night I had severe indigestion and some diarrhea. The next morning we returned for the results which found no bacteria and all normal except for a small amount of Blastocystis Hominis. Later that day, despite trying to eat simple foods, bread, bananas, rice, and some vegetables, I developed severe stomach cramping to the extent that it was painful to walk and very uncomfortable in any situation. We went back to the clinic where my feces had been tested to see a doctor (5 soles for the test, 4 to see the doctor). After poking around my abdomen where a few spots hurt some but no shooting pain, just general cramping and pressure, the doctor wrote me a prescription for Ciproflaxin. We didn't understand since the test had found no bacteria but she believed that I have a bacterial infection in my stomach. After the 7 day regimen of Cipro she prescribed Nitoxozanida or Colufane (slightly different deciphered spellings on these doctors notes but I believe the same medicines as before) twice a day for three days to finish off the Blastocystis Hominis.
April 18-April 26: Ciproflaxin 500mg tablets at 9am and 9pm daily while abstaining from alcoholic drinks and trying to eat simple food.
After asking about probiotics, the doctor also gave me a prescription for Enterogermina, spores of polyantibiotic resistant bacillus clausii to take once daily for five days. I have been feeling a little better but my energy levels are still low and my digestion has not been good. I have not had diarrhea, just some cramping, bloating, and discomfort.
April 25, Arequipa, Peru. We got off an overnight bus from Nazca to Arequipa this morning and despite a slightly funny stomach I had plenty of energy to tromp around the city with our bags and find the best hostal deal. Walking into the seventh or eighth hospedaje of the morning I was greeted by a middle aged guy smoking a cigarette who said he could give me a room for two people for 30 soles (around $11). The place had Wi-Fi and a kitchen on a quirky but nice rooftop terrace, even a place to wash clothes, so I asked for 25 soles. The friendly guy declared it was his birthday so he would do it and asked if I wanted to have a vodka drink with him! I wished him 'Feliz Cumpleanos!' and gave him a chocolate Amy had picked up back in Ica. I then had to explain to him that I was taking antibiotics and despite the tempting screwdriver offer at 11am, I would have to pass. I felt good most of the day but had a lingering headache I made sure wasn't dehydration and this afternoon my energy abandoned me. My last Cipro pill goes down the hatch in the morning and then it will be on to the Nitoxozanida for three days. Maybe soon I will feel healthy again.