Notes on Travel, part 2 - 8/15/2005
Before traveling to India, there are a variety of vaccinations and medications that one is supposed to take. The travel-mages at Kaiser saw fit to shoot me up with a vaccine against Hepatitis A, as well as boosters for polio, measles, tetanus, mumps, etc. I'd thought that I'd seen the last of those guys years ago, but apparently they're suggesting a second round of boosters for folks after their early twenties. Besides the injections, they gave me an oral vaccine for Typhoid, anti-malarial pills, some sort of nuclear-strength antibiotic, and stern warnings about drinking anything but bottled water.
The oral typhoid vaccine was kind of a pain— it contained live attenuated typhoid culture, and as such had to be kept refrigerated (but could not be frozen). This wouldn't have been a problem except for the fact that I was leaving for Wyoming smack-dab in the middle of its course of treatment. How were we to keep the vaccine cold while on an airplane? After consulting with our friend who works for the TSA, my clever s/o rigged up a solution involving an insulated lunch bag and several soft ice packs. This, our friend assured us, would make it through security without any problems.
I wasn't so sure- what could possibly look more suspicious on an x-ray than several small capsules elaborately packed in ice? My concern, however, was un-necessary— we made it through without incident1. Everything was fine, and we made it to Wyoming as planned. Once I finished the typhoid vaccine, it was time to start the anti-malarials— you're supposed to start them a week before you leave.
I took the first pill Wednesday morning, and felt fine... until Wednesday night. I had some of the strangest dreams I can remember having in years. The same thing happened on Thursday and Friday nights as well. Also, I found myself feeling progressively more anxious and tense. This was noteworthy as I am, by nature, generally a very calm, relaxed person. At first I thought I was just fretting about my upcoming trip, or perhaps about how I was going to pay for some significant car repair that had been done while I was out of town. As the tension got worse day by day, though, and became less and less about anything in particular, I began to question my initial hypothesis, and finally remembered that the number-one listed side-effect of Mefloquine is sudden feelings of anxiety, paranoia, tension, etc.
Bingo.
A quick call to the pharmacy confirmed that my sudden pronounced anxiety and strange dreams were almost certainly the result of the drug, and that they'd go away as soon as I stopped taking it. The problem, of course, is that I was looking at two more months of this. Obviously, it's better than malaria... but if there's an alternative to spending the next couple of months worrying myself sick, I'd like to take it. So, they're switching me to a daily antibiotic, which, in addition to fighting off plasmodium-borne disease, will also help keep my digestive tract free of any bacteria that might find there way there whilst I'm in India. Ordinarily, I'd be against taking an antibiotic for that long... but in this case, it might be okay.
The whole episode leaves me with two main questions:
[Update 10:15 pm PDT 8/17/2005: Upon returning to Portland, I did some digging and found out that the best-guess explanation for the first question involved some stereochemistry- apparently, the mefloquine molecule is chiral, and only one of the enantiomers (I forget which) is effective against malaria— the other seems to mess with some adenosine-uptake pathway. Apparently, this is why there are so many strange psychological side effects. Still no answer w.r.t. the second question]
1 Un-needed, perhaps, but not necessarily unfounded. It's very odd— pre-September-11th, I used to get no end of hassle at every airport security checkpoint I went through. I was always the guy who got to be padded down and wanded while watching an entire team of agents dissect his carry-on baggage. It had always been this way, and when I learned about the tighter security measures that were to come in the wake of September 11, I was sure that "now I was really in for it". However, ever since then, for whatever reason, I've had next to no trouble with security. But I digress.)
The oral typhoid vaccine was kind of a pain— it contained live attenuated typhoid culture, and as such had to be kept refrigerated (but could not be frozen). This wouldn't have been a problem except for the fact that I was leaving for Wyoming smack-dab in the middle of its course of treatment. How were we to keep the vaccine cold while on an airplane? After consulting with our friend who works for the TSA, my clever s/o rigged up a solution involving an insulated lunch bag and several soft ice packs. This, our friend assured us, would make it through security without any problems.
I wasn't so sure- what could possibly look more suspicious on an x-ray than several small capsules elaborately packed in ice? My concern, however, was un-necessary— we made it through without incident1. Everything was fine, and we made it to Wyoming as planned. Once I finished the typhoid vaccine, it was time to start the anti-malarials— you're supposed to start them a week before you leave.
I took the first pill Wednesday morning, and felt fine... until Wednesday night. I had some of the strangest dreams I can remember having in years. The same thing happened on Thursday and Friday nights as well. Also, I found myself feeling progressively more anxious and tense. This was noteworthy as I am, by nature, generally a very calm, relaxed person. At first I thought I was just fretting about my upcoming trip, or perhaps about how I was going to pay for some significant car repair that had been done while I was out of town. As the tension got worse day by day, though, and became less and less about anything in particular, I began to question my initial hypothesis, and finally remembered that the number-one listed side-effect of Mefloquine is sudden feelings of anxiety, paranoia, tension, etc.
Bingo.
A quick call to the pharmacy confirmed that my sudden pronounced anxiety and strange dreams were almost certainly the result of the drug, and that they'd go away as soon as I stopped taking it. The problem, of course, is that I was looking at two more months of this. Obviously, it's better than malaria... but if there's an alternative to spending the next couple of months worrying myself sick, I'd like to take it. So, they're switching me to a daily antibiotic, which, in addition to fighting off plasmodium-borne disease, will also help keep my digestive tract free of any bacteria that might find there way there whilst I'm in India. Ordinarily, I'd be against taking an antibiotic for that long... but in this case, it might be okay.
The whole episode leaves me with two main questions:
- Why would an antimalarial be screwing with my brain chemistry enough to cause significant mood/affect changes? What is going on there, biochemically?
- Why would an antibiotic— which is designed for use against bacteria and other prokaryotes— work against malaria (which is caused by a protozoan?)
[Update 10:15 pm PDT 8/17/2005: Upon returning to Portland, I did some digging and found out that the best-guess explanation for the first question involved some stereochemistry- apparently, the mefloquine molecule is chiral, and only one of the enantiomers (I forget which) is effective against malaria— the other seems to mess with some adenosine-uptake pathway. Apparently, this is why there are so many strange psychological side effects. Still no answer w.r.t. the second question]
1 Un-needed, perhaps, but not necessarily unfounded. It's very odd— pre-September-11th, I used to get no end of hassle at every airport security checkpoint I went through. I was always the guy who got to be padded down and wanded while watching an entire team of agents dissect his carry-on baggage. It had always been this way, and when I learned about the tighter security measures that were to come in the wake of September 11, I was sure that "now I was really in for it". However, ever since then, for whatever reason, I've had next to no trouble with security. But I digress.)
posted by steve | 11:50 PM
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