May 9, 2019

Travel Medical Adventures (Warning, Dog Bite Photos)

Hello from the other side of the longest I've gone without blogging since 2003.  I didn't miss it at all, which surprised me.
Tulips on the way into AMS (before our quick hop to CDG)
Given that I've habitually blogged at least once a week for 16 years, I spent some time trying to understand why it was so easy to let it go:

1. I have Instagram and Twitter if I really feel the need to project my words/pictures, and they are faster and easier to use.

2. Over the years, I've gotten less and less dedicated to the actual craft of writing on this blog, *and* I've gotten less and less specific with the details I share. This means the blog has really shrunk down from a general purpose somewhat redacted diary with intermittent writing exercises to more of a running, fitness, travel, food, and reading tracker -- e.g. useful, but not a particularly creative pursuit.

3. I was preparing for and enjoying a 19-day trip, with at least half of it completely off work.  During our Sabbatical year, I blogged about our experiences and observations as part of the fun of the travel.  I built in time to prepare blog posts after each new location, to help me process and record my thoughts while they were fresh before I went to another place. On this vacation, I believe the longest one I've ever taken while working, I really wanted to just focus on enjoying the trip in the moment and minimizing the activities that could feel like work.

Chefchauoen, Morocco -- the blue city

Our original plan had been to fly round trip to Paris (because any chance I can build in a France visit, I will, and also because we weren't sure what might happen with Brexit at the time we booked our flights, so we wanted an option to bail out of England if necessary).  After one night in Paris to manage jet lag, we planned to fly to Morocco and visit Chefchaouen and do some hiking there, followed by a visit to Marrakech and hiking in the Atlas Mountains.  From Marrakech, we had flights to London, where we'd cheer on Jen at the London Marathon, visit London friends, possibly do some hiking in Wales, and then close out the trip with an awesome weekend full of Wiltshire adventures with Jen & Gypsy Runner as guests of Cat and her family and cats.

Roughly our route, except we flew from Fes to Marrakesh
How did we pick Morocco?  Well, I wanted to visit a country we'd never been to, and we wanted to do some hiking.  E had never been to Africa, and we knew we wanted to start in France, which made Morocco an easier option due to its history as a French protectorate and popularity with French-speaking tourists.  Once we decided to go, E's dad decided to come along as well, which made for a fun family trip.

Day 1 hiking, Chefchauoen in the background
Unfortunately, on the first day of hiking, despite having a local guide, I got bit by a dog.  We were on public hiking trails, but the dog's owner had a marijuana farm near the trail and the dog was a bit too territorial.  There were two dogs, actually, a black one that came running at our group towards the guide in the front of our single file line, and a yellow one that came at the back of our line (me).  The dog was loudly and angrily barking and I was oddly calm in the certainty that I was going to get bit.  I chose to keep my back to it, and sure enough, it did quickly nip at my heel, slicing through my wool socks and leggings and then it ran away.  It was a quick sharp slice, and it didn't actually hurt that much.  I was surprised when I pulled my sock down and saw how deep it actually was.  Later, I felt very grateful when I saw the other scrapes on the outside of my calf from the teeth that didn't puncture. Any deeper in the lower part and it would have injured my achilles.  Any deeper up above and it could have seriously injured my calf muscles.  I was very lucky and extremely thankful.

Within 30 seconds of me explaining that I'd been bitten, our guide rinsed it with saline, applied betadine, and wrapped it with gauze.  He then called a jeep to come get us and we went to the hospital, where they cleaned the wound, gave me a tetanus shot in my stomach, prescribed antibiotics, and sent me to the municipality for 2 doses of the rabies vaccine and a card instructing me to get another dose in 7 days and another dose 14 days after that.

I'd already been taking it relatively easy, athletically, on this trip, in the hopes of calming down my pesky left hamstring/glute, but now it appeared that I'd be taking it *very* easy.

2 days post injury
On day 7, I got myself in to see a travel doctor in London, and they informed me that Public Health England disagreed with the regimen that Morocco had prescribed.  They wanted Immunoglobulin injected into the bite site (actually the most painful part of this whole process) as well as vaccinations on day 7, day 10, and day 21.  So, E and I took the train all the way out to Colindale and back to pick up Immunoglobulin and vaccine doses, which we took back to the clinic for evening treatment.  (Side note -- if you ever need treatment for travel-related medical issues in London, Dr. Dawood and the team at the Fleet Street Clinic is for you.  The first travel-clinic I tried shrunk in horror at the idea of post-exposure rabies treatment and sent me to them. They were wonderful.)

Monday's London vacation activities were:
laundry, Dishoom
and several hours of medical stuff with lots of public transit

Day 10, instead of staying in the lovely English countryside, we spent about 2 hours going from the adorably named Castle Combe back to Fleet Street Clinic for another vaccination (the vaccines had to be kept refrigerated and administered by someone PHE trusted) and then another 2 hours or so heading back to Wiltshire, where we met up with our friends.

Castle Combe -- does it get any more quaint?
Once back in the US, I called my local travel clinic and learned that the US doesn't agree with either the UK or Morocco about the treatment regime.  So, tomorrow, I'm headed in for my last and final vaccine dose (day 17 instead of 21).

I did do a little bit of hiking and jogging in the last couple of weeks, and it didn't really hurt, but the wound is actually fairly deep and most of those activities seemed to open up the most recently healed areas. So, I'm going to hold off any "training" until it's fully closed up and healed over.  Wish me luck.

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