Post-Malaria thoughts

I'm knocking on my forehead(you know, knock on wood) as I write this, hoping that the last couple of blood tests confirming I am Malaria free remain correct going forward. What an "adventure" as my dad put it when I called to tell my parents that I had contracted a bout of Malaria. An adventure, sure - if you count cycles of relentless sweats, pressure headaches, bone rattling uncontrollable chills, and oh so much heat on your list of to-do's. :)

Anyhow, as Lisa put it in her post I was the lucky host of P. falciparum (click here for the wiki link) Malaria parasites, contracted as best we can tell at the Tiki bar in camp in the last 21 days. Why me you ask? Because I was lazy with prevention, the blame lies solely with me. Like most expats that do a lot of time here you grow very comfortable with the fact that you have not contracted malaria in your time here. As we are not short term visitors, medically, it is inadvisable to continue taking anti-malarial drugs past 3 months and simply practice prevention through long pants, shoes, and spray during the ~1.5-2 hours a day that you are at risk (6PM-8PM) of bite. So wearing shorts, flip flops, and sitting outside during that time frame at the Tiki bar for the last 20 months on a regular basis it was really just a roll of the dice.

You see, Malaria isn't something that the mosquito acquires naturally as part of it's lifecycle. Mosquitoes actually have to bite someone else infected with Malaria and then bite you in order to infect you. The parasite itself actually lives in the saliva of the mosquito(yum) rather than the blood and is transferred with the initial bite. So to be infected you have to a)be out and about when the particular type of mosquito can be due to temperature/humidity b)be exposed and not wearing spray c)get bitten by the exact type of mosquito that can carry d)said mosquito must have bitten someone who was infected with Malaria within it's short 1 month lifespan e)within 2KM since they are only able to travel that far at a maximum during their lifespan. Add on top of that the fact that there have been no expat infections in the camp in months (I am one of 5 ever to get it from our expat community) and I won the Malaria lottery! Somehow I don't feel so lucky. Is this how the powerball winners feel? Hmm..

Anyway, treatment was pretty simple for those curious, I was admitted, tested, confirmed, and put on the following:

• 2 x daily x 3 days - 4x50mg Coartem (link)
• 2 x daily x 5 days - 1x50mg Doxycycline (link)
• Large amounts of oral & intra-muscular anti-inflammatories/pain killers to treat the symptoms (fever, headache, chills)
• Daily blood tests confirming organ function & parasite levels
• 12 x daily blood pressure, temperature, and blood oxygen level checks (these are fun at 2AM)
• Copious amounts of complaining to Lisa and milking every bit of sympathy I could (thanks dear)

Coartem is pretty neat, it's a combination of drugs that kills the parasite and the first approved by the FDA for use in the United States in '09. Very effective, quite "light" in terms of it's impact & side effects and actually tastes oddly like a fruit candy rather than the horrible tinny flavour of Doxycycline. Common side effects include Anorexia (SCORE!), death, and something else I didn't read. Kidding about the death bit.

Anyway, last blood test yesterday confirms I have no parasite levels in my blood. Minor symptoms including my current headache and temperature fluctuations are common for the next couple of weeks. Long term I can expect anything from full blown recurrence(low chance of that) to never having an issue again. I am told my immune system will actually actively kill P. Falciparum parasites should I be bitten again in the next ~4 months, but going to do my best to not test that theory.

Thanks to all for the love, support, and messages - they are definitely appreciated. Thanks also to Lisa for being totally awesome and sitting in my wonderful hospital room for 3 days whilst I enjoyed providing the utmost hospitality to Malaria.

Cliff's Notes:

• Had Malaria, it sucked
• Cured (hopefully)
• Am not a walking disease vector (for Malaria anyway)

More reading if you aren't suitably terrified:

1. WHO Malaria Fact Sheet
2. CDC Malaria Fact Sheet
3. Coartem fact sheet

Pineapple Upside Down Cake - make this now, it's amazing!

So being that I now have the time to experiment in the kitchen, and am trying all sorts of new things, I thought  would post the ones that I liked the best on here for the sake of not losing the recipes, and so you could give them a try.

I am not a huge fan of pineapple, but I planted pineapple plants in my garden a few weeks ago. Turns out that to plant those, all you do is chop the top off a pineapple and stick in the ground. This left me with 8 pineapples to do something with. I will share two of the recipes. This one was by far the most popular. Rave reviews from everyone at the potluck as well as people we have had over for dinner. So moist and delicious.

fresh market pineapple

Ingredients:

4 eggs
1/2 cup butter
1 cup packed light brown sugar
1 (20 ounce) can sliced pineapple (I used 20 ounce fresh chopped pineapple)
10 maraschino cherries, halved
1 cup sifted cake flour
1 teaspoon baking powder
1/4 teaspoon salt
1cup white sugar
1 tablespoon butter, melted
1 teaspoon almond extract

Directions:

1. Preheat oven to 325 degrees F (165 degrees C).

2. In a 10 inch heavy skillet with a heat resistant handle, melt 1/2 cup butter or margarine over very low heat. Remove from heat, and sprinkle brown sugar evenly over pan. Arrange pineapple slices to cover bottom of skillet. Distribute cherries around pineapple; set aside.

3. Sift together flour, baking powder and salt.

4. Separate the eggs into two bowls. In a large bowl, beat egg whites just until soft peaks form. Add granulated sugar gradually, beating well after each addition. Beat until stiff peaks form. In a small bowl, beat egg yolks at high speed until very thick and yellow. With a wire whisk or rubber scraper, using an over-and-under motion, gently fold egg yolks and flour mixture into whites until blended. Fold in 1 tablespoon melted butter or margarine and almond extract. Spread batter evenly over pineapple in skillet.

5. Bake for 30 to 35 minutes, or until surface springs back when gently pressed with fingertip. Loosen the edges of the cake with table knife. Cool the cake for 5 minutes before inverting onto serving plate.

Not beautiful but I promise it is oh so delicious. Top it with whipped cream and you'll never want another kind of cake again!

*** I do not have a cast iron skillet, or one with a heat resistant handle. I have a pie pan that is large, so I made the cake in it and just melted the butter in a little pot and transferred it. The surface of the cake is brown and mine was cracked a bit when finished. Also, make sure you gently do the loosening with knife so that you don't gouge the sides of your cake, but do not skip this step. It will not come out of the pan when you flip it over otherwise.

Recipe credit from http://allrecipes.com/Recipe/Old-Fashioned-Pineapple-Upside-Down-Cake/Detail.aspx?event8=1&prop24=SR_Thumb&e11=old%20fashioned%20pinapple%20upside%20down%20cake&e8=Quick%20Search&event10=1&e7=Home%20Page&soid=sr_results_p1i1

Malaria Sucks...

...a lot.

This past weekend, Matt and I were supposed to be heading out with our friend Ian on a 4 day bike and quad adventure up the coast. Matt hadn't been feeling like himself for the past week or two, but attributed it to work stress and was looking forward to the time off of work and out of camp.

On Tuesday afternoon, he noticed that his knees hurt, which usually means for him that the flu is on it's way. We went to bed and he tossed and turned most of the night. Wednesday morning he got up to get ready for work and said that he had what felt like a migraine. It hurt to have his eyes open. He went to work anyway. By the time he got to work he was sweating uncontrollably. He went to talk to his boss, who took one look at him and told him to go come, he looked gross. It is about a 15 minute walk from his office to our house, and by the time he got here he had completely sweat through his clothes, including his jeans. When he walked in the house my first thought was that he looked like he had stood in someone's sprinkler for a while.

He changed his clothes and laid on the couch, the sweat stopping after about a half hour. He fell asleep for around 40 minutes, and when he woke up he was shivering uncontrollably. I got him a blanket, as we initially thought he was just cold from the air conditioning. The shivering didn't let up and he decided to get in the shower. I got layers of clothes ready for him and a hot towel in the dryer and let him be. I went to check on him about 10 minutes later and even though the shower was almost scalding hot and he wasn't shaking anymore, his lips and under his eyes had turned blue. I immediately told him to get dressed, we were heading to the clinic.

Our vehicle does not have plant access, and the clinic is on plant site, about a 20 minute drive from our door to the clinic door. This is not a distance that Matt could have walked. I called up a friend who's vehicle has access and we borrowed her driver and headed to the clinic. The minute we walked in they noticed the blue tinge to his face and put him in a treatment room. They checked all the standard things - eyes, ears, throat, temperature - and did a malaria test. It almost immediately went positive. Everything was making sense now, as he was experiencing classic symptoms of malaria.

A regimen of anti-malarial medication, as well as pain meds were started, and he was admitted to the clinic for a minimum of 72 hours. The real pain with malaria is that the fevers and chills are cyclical. You feel great for a little while and then you feel a headache coming on, and your fever spikes and you are in a remarkable amount of pain that is hard to do anything about. You just need to get the fever down. I watched Matt go through 4 of these cycles. The one at home on Wednesday morning, and then one on Thursday morning were the absolute worst, though he says over night that first night in the clinic was pretty bad as well. I never want to see anyone go through something like that again. The pain from the fever (it was over 40 degrees), was intense, and it took 2 ibuprofens, a codeine, and eventually an injection of pain meds to give even a little bit of relief.

He finally fell asleep around noon on Thursday and slept until 4:30, and woke up feeling a bit better. Luckily we were now past the first 24 hours and things were looking like they might improve. Although there was the occasional fever, he never spiked over 40 degrees again, and was able to come home on Saturday morning after three miserable days in the tiny little sardine can of a room he was in. 

He continues to improve, though the fevers can still happen for up to 10 days, so he is off work until at least Wednesday. They are sure that the parasite is gone. This was confirmed every single day with blood and urine tests. He needs to keep going on the medication for a little while longer just to make sure, but it looks like he is in the clear.

They told me at the clinic that it was going to be alright because he had non-complicated malaria and it was going to be easy to treat. We got the official name today and I did some research. They are dirty rotten liars. But first:

Malaria Selfie!

A card from the guys when they came to visit - they are hilarious..

:( - the wrist brace is from a quad incident, but that's another story.

Spending three days on a bed that's so small you can't even stretch out flat is pretty miserable. This is the size of the entire room. So small. Though it did have it's own comically tiny bathroom.

So it turns out that Matt had Falciparum Malaria. According to Wikipedia, this is the malaria that causes the highest number of malaria deaths. Great. They did not tell us that at the clinic, assuring us that it was good, we had caught it early, and he would be fine. They are very smart. I would have lost my mind.  Luckily, Malaria is no longer the kind of parasite that continues to come back and haunt you for the rest of your life. Once it is treated and killed with the meds, it is gone. There is no vaccine for it, but it can be killed. Living in a Malaria zone means that you may get it again, but only if you have the unfortunate luck of being bitten by an infected mosquito again. The mosquito only gets infected by biting someone that has malaria and then biting you. They are not carriers of the disease on their own. It is also only certain kinds of mosquitos (females) in a certain period of their lifespan, that can only fly a maximum of 4 feet off the ground. So basically it's those damn ankle biters.

For those that are interested, here is the Wikipedia article on the kind of malaria:
http://en.wikipedia.org/wiki/Plasmodium_falciparum

And here is one on malaria in general:
http://en.wikipedia.org/wiki/Malaria

There are anti-malarial drugs that you can take, but they are not recommended for more than three months as they basically tear apart your liver. So the best practice here is to be religious with bug spray that has deet, and to cover up at night. It is far too hot during the day for them. I am going to invest in large amounts of citronella things, and am going to be looking for tiki torch type things that burn citronella oil so that I can put them around our little back yard, as we love to sit on the porch and play cards in the evening.

We are also very lucky to have a lot of support here. Matt's boss immediately made calls to ensure I had a vehicle with access on plant site so that I could be with Matt as often as I wanted, friends gave up their driver to get him there, we had constant phone calls and text messages (from people here and people at home) checking on both of us, on Thursday night a friend made me dinner when I got home late from the clinic, and we had tasty fresh out of the bakery oven chocolate croissants brought to us. Ian doesn't even hate us for cancelling on him a day before we were supposed to leave. People are awesome <3.

Rest assured that Matt is recovering nicely, has no organ damage or lasting effects, and is doing very well. Now lets just hope that I don't get it either - I am much more of a suck :)