Wednesday, December 2, 2009

Things that make you pause...

Ange and I are going to Senegal & The Gambia over the holidays. I was invited back to the trip that I assisted on this summer with Emil and as part of my signing back on I was able to negotiate Ange coming with us. Sweet huh?

Now Ange has never been to Africa, or anywhere outside of the US besides the Bahamas, so she needed to get a long list of vaccines that are required for travel in most developing countries. That whole process is not as easy as it may sound. First there is finding out what vaccines you need. Then there is figuring out which ones may be covered by insurance (if you have it), then figuring out what doctor's offices or clinics have the vaccines you need, then you have to figure out how far in advance you need to get the vaccines (and if they are multi-series vaccines how many times you have to visit and how that factors into the timeline), then there is the budgeting for the tremendous amount of money you have to spend, and finally you make all of your appointments to the (likely) many places you need go to get said vaccines. So Ange did all that (with some assistance from her well traveled partner :)) and started making her rounds. She went to her primary care physician to get her first dose of HepA and meningitis. She had an appointment to see the travel doc and get her typhoid and yellow fever, but in the midst of that the H1N1 vaccine came out and Ange's employer was only giving out the nasal mist to its employees, which if you didn't know, is a live vaccine. Sometimes live vaccines can't be given in conjunction with other vaccines so I suggested she call the travel doc and check. I was correct and she had to reschedule the travel appointment for one month after the H1N1 mist.

That month finally rolls around last Wednesday (day before Thanksgiving--this is important) and because it is Thanksgiving week I am home from Bloomington so I decide to go with Ange to her appointment. One for moral support (I've been through it all and know the doc she was going to see--he's done all my travel stuff), and two, I actually love going to doctor's appointments because I'm attentive (and probably annoying) and I always learn something new and useful. When people ask me why I know so many random health things this is why.

So we get to the doctor's office and fill out some paperwork and whatnot and then go back to his office. Now this doctor is really and truly the best travel doc in Indy. He is the only specialist in his practice (but shares office space with another practice that has a different specialty) so it's very personal and one-on-one. He has a really cool office with a big comfy couch and a giant map of the world on one side. He schedules new patients for an hour long session to go over A to Z info with you, prepares a little info packet with a ton of info on the country/countries you are visiting and generally reminds me of an "old school" doctor that is now very rare. He answers any question you ask in a thoughtful and very explanatory way and generally makes you feel very prepared for your trip (from a health perspective anyway).

So we sit down and the doc starts doing a little health assessment questionnaire with Ange that covers basic health and limited health history. After all the standard questions about current health status comes the biggie question that I've learned to anticipate and take in stride, "Are there any other medical conditions that I haven't listed that are important?" I think I've mentioned before but Ange had leukemia as a child, and not just any leukemia, an extremely rare form of leukemia, rare as in there were only 3 people in the US that had the same kind when she was diagnosed. It was also a very aggressive cancer that had to be treated very aggressively. This question always makes the doctors pause for a minute, they sometimes ask a few more questions about it, but generally it is noted and not mentioned again.

This time was different.

Apparently cancer and vaccines aren't the best of friends. The doc was very hesitant about treating Ange with any live vaccine without the consent of her oncologist. For the adult polio booster she was also going to get, no biggie. It's a dead vaccine. For typhoid, we could get around that. Typhoid comes in a live vaccine (lasts longer) and a dead vaccine. So she could get the dead one. But for yellow fever there is only a live vaccine. And it's a pretty potent one apparently. The doc relays this info to us and tells us that even in people who have not had cancer in a very long time, there is some evidence that shows that their immune systems are not 100%. Under normal conditions you don't even know this. Your body just operates like normal and no one is the wiser. However, because the yellow fever vaccine is so potent he was afraid that if he immune system was not 100% it would not be able to fight off the live virus and she could either have some very gnarly side effects (like Encephalitis) or even get a full blown case of yellow fever. Another random health fact: there is no cure or treatment for yellow fever, and there is a 50% chance of dying if you get it. Yikes.

So the doc asks her how tied to this trip she is and would she consider not going. Um, no way. So we talk some more about the risks involved and related issues and decide that the best plan of action would be for her to call her oncologist and check out the situation. If they say no prob then great, if they say no way then she is going to go into a yellow fever endemic area basically unprotected. Yikes again. Now, yellow fever is spread through the mosquito. Luckily she can protect herself by using lots of bug spray. Secondly, there are not that many mosquitos in the areas we go. Finally, the doc pulled up some fancy data system and looked at the rates of yellow fever in Senegal and The Gambia and determined that the last outbreak of yellow fever in Senegal was 2005 and in the 1970's for The Gambia. We are spending nearly all of the time in The Gambia so that was good news. But the other thing that was concerning for us was that you have to show proof of yellow fever vaccination to enter most yellow fever endemic countries and to return to the US (technically). I have never had anyone ask me for my yellow fever card in my entire history of traveling, but knowing our luck, it will happen this time. You can get a waiver certificate and the doc would also provide a letter of support to say she couldn't get the vaccine but there is no guarantee that the countries we are entering would accept it. Sometimes, they don't. Just depends who is asking at the moment. SO, not the best case scenario.

The doc tells Ange to contact her oncologist and then follow up with him. Here's the major issue. Ange was diagnosed when she was 4, was treated for 18 months, went in to remission, received periodic appointments to make sure she was ok and hasn't seen an oncologist since she was 12. She's 28 now. So who the hell is she supposed to call? A random oncologist? Her oncologist, who we don't even know if he is still in practice? The doc suggested we start with a call to Riley (where she was treated) and see if they could make some recommendations. So we finished up there and went to lunch with a lot on our minds.

I swear when we got in the car I thought Ange was going to cry. The whole news was so overwhelming and unexpected I think we were both in shock. I mean, traveling to Senegal and The Gambia are no big deal. Really, there were so few mosquitos in comparison to Nigeria it was incredible. But Nigeria? Forget about it! There is no way that I would even allow Ange to come and visit me in Nigeria if she were unvaccinated. I mean, we talked about it and it came down to this: if it were something that were treatable and she just might get really sick then that's one thing. But the fact that it isn't treatable and there is a 50% chance she could DIE? That's nothing to mess around with. So of course that is problematic since I intend to work in Africa and most of Africa is yellow fever endemic. So that means either I will have to travel alone for a majority of my career or I'd have to change research locations. Both huge things.

So Ange is still upset and is feeling very overwhelmed. So she asks me to start with the calling. Now here is where the whole Thanksgiving this is important. Ange has to have the vaccine by December 20th at the very latest for it to be effective. Additionally, if there is a chance that it's going to make her really sick we want to make sure we are still near good medical care and not on a plane or halfway around the world. So with Thanksgiving falling late this year, we knew that if we had to wait until after the break things were going to get tight, especially if she needed to get tests and whatever else might come along with making sure your immune system is normal. So as we are driving to lunch I find the number for Riley's Pediatric Oncology Clinic and go through this long spiel of why I am calling. Luckily the lady in the clinic was SOOOO NICE! Which I should have expected from Riley, but you know, these days customer service generally blows so I'm just used to talking to idiots on the phone. She gets all the info and tells me that she'll call me back before the end of the day with an update. She knows she may not get a lot of info being that it's the day before Thanksgiving, but she wanted to get the ball rolling.

We go in and have a very morose lunch, drive home feeling more depressed, and try to do some internet research. The internet research was actually helpful to me, although not to Ange who really looked like she wanted to throw herself off a bridge for the rest of the day. I found out a lot of more reassuring info via the net, but unfortunately for every piece of good news, there still seemed to linger some bad news. For instance, since the 1970's only 9 unvaccinated travelers have gotten yellow fever in all of West Africa. That's pretty good, right? BUT, 8 out of those 9 DIED. Scary.

The lady from Riley did call us back a few hours later to let us know that she had tried to find Ange's file but since it was so long ago it had probably been archived and it would take a request to get it out of the archives which make take a few days. She had also emailed the Infectious Disease specialist at Riley as well as one of the pediatric oncologists. She told us she'd update us after the break. Swear, such a nice lady.

The rest of the break we tried not to dwell on the issue and did a good job of keeping out of the focus of our minds. Luckily Ange bounces back quickly so I didn't have to worry about her sanity. We decided to just keep the what ifs until later after we had a definitive decision.

Well wouldn't you know, our wonderful friend of Riley tracked down the right people and on Monday Ange got a call from a doc at Riley giving her the go-ahead for the vaccine! He actually said there was NO REASON to hesitate about it. We had already discussed the fact that we thought our travel doc was just being extra cautious and that since he wasn't an oncologist he could just be way off on the real danger. Turns out, we were right about that! This is not to say we are angry or upset by the whole fiasco. We think it's excellent that the doc was able to be informed (even if overly cautious) and really and truly had Ange's health as the focus. Luckily it was patched up very quickly, it just sucked that we had to worry over the holiday.

Anyway, Ange gets the vaccine tomorrow. Yay! So happy that my little love bug gets to travel the world with me and we don't have to worry about her dying from yellow fever! Just one more thing to be thankful for this holiday.


ange said...

Good blog, do not LOVE to go to doctor's appointments. When I asked you to go, you were so hesitant and continued to be pretty much up until that day. With that said, thanks for coming along, whether against your will or happily.

I'm ecstatic that we didn't have to rearrange our entire lives due to this fiasco. NONSENSE. BEst part is, Dr. J didn't treat me like a dart board! HOORAY for traveling!

Diva of Diversity said...

FYI-- I actually do LOVE going to doctor's appointments.

What I do NOT love is pre-planning and committing myself to things in advance. I'm much more spur of the moment. Especially if it means changing out of sweats and getting off of the couch.

I'm actually going to have to blog about this phenonmenon because it is vitally important to understanding me.