My patient, love-hate relationship with my parasitic disease continues to evolve:
One-sentence summary: NIH pathology results confirmed the original Peruvian diagnosis and parasitic strain; began my 28-day cycle of oral medication as projected; am currently short-leashed and on-watch for adverse reactions to the new drugs.
Right Now: This weekend I fled my PC-DC hotel bunker and I am in hiding at Kristin’s parents’ home in Annapolis, Maryland.
I seem to keep showing up here. They continue to graciously and warmly welcome me, unfazed.
Expression of the Week: “Only one way to find out.”
Many of my friends are also doing very brave things like leaving their jobs, buying businesses, moving to California, confronting addiction, and saying yes to falling in love. Only one way to find out.
Week Thirty-Seven was expert-level Waiting and Adjusting of the Plans. Akin to a deliberate, high-intensity workout of the brain and heart– I have been sitting still, breathing, remain open, and adapting accordingly. I am grateful I had this past twelve months to practice [e.g. letting go of any semblance of control] during service.
Since I am out of good, sexy, bloggy content I’ll make this week’s episode a semi-unprofessional tutorial on a Neglected Tropical Disease (NTD) called Leishmaniasis.
Dammit. I am no longer rare. I am just neglected.
Leishmaniasis is the tropical disease caused by a parasite called leishmania. You get it during a successful vector transfer (bite) from a tiny type of mosquito (sandfly) who is infected with a leishmania parasite. For a successful transfer of the parasite to human host, the sandfly must be female, pregnant, and carrying the promastigote in its throat when silently, invisibly, tiny feasting on your body.
Leishmania parasites live and swap hosts in tropical and sub-tropical parts of the world, occasionally taking a summer to backpack through parts of Europe.
“Mike,” my afore-named incorrectly self-diagnosed “botfly larva” from Week 34 [wow so wrong] turns out is actually (after a few months phagocytizing) Lots O’ Mikes. It takes awhile, but the little guy I got from a jungle-baby-mama sandfly got captured by a healthy cell trying to protect the rest of my body from the foreign invader.
Then the promastigotes turned into amastigotes and killed my cell, eventually building up an open sore of murdered and defeated cells, and released a bunch of newly minted Mikes in my arm. Rinse and repeat: healthy cells fighting invader, invader making mad mitosis happen, kills the host cell… an onward we march.
Unhealed bug bite + small tantrum in the doctor offices + poor use of Youtube research video sometimes gets you upgraded to a chronic lesion.
This week NIH’s pathology lab confirmed the strain of parasite to be L. braziliensis, strongly favoring the conjecture I picked up Mike in Manu National Park, back on a birding river trip over Thanksgiving.
From the CDC website: “Examples of people who may have an increased risk for infection (especially with the cutaneous form) include adventure travelers, ecotourists, Peace Corps volunteers, missionaries, soldiers, ornithologists (people who study birds), and other people who do research (or are active) outdoors at night/twilight.”
Whoops. That’s like 5 out of 7 right there. Strong work. Take home lesson: Birding is wicked dangerous.
We believe (and hope) that I have the cutaneous flavor of leishmaniasis. Generally people take two years and really nasty ear/nose/throat complications to seek out treatment and subsequently have to spend 100 more years or so to diagnose, because, as mentioned above its an “N” in the NTD category.
Why so lucky? I just happened to survive a bridge collapse where I landed on my right arm which lead me to physical therapy and I was embarrassed enough by my unhealed bug bite in the same area that I made so much noise and threatened to remove Mike myself with a scalpel that I got the attention of a doctor in PC Peru who happens to read weird neglected tropical disease journals for fun in her spare time.
And here we are.
Week 37 of Peace Corps service hanging out in winter shells like one-eye pirates.
Some other fun facts:
1. No one at Peace Corps Peru has seen/had leishmaniasis. [Ding ding ding goes to Jess Rice for originality.]
2. No one in the Peace Corps South America Region has seen leishmaniasis, nor brought a case back to DC for the NIH to play with, according to my PC handlers in DC.
3. The state “Madre de Dios” (next to Cusco) in Peru has been “red-zoned” as of this week (no more PCVs allowed, sorry) due to “terrorism and human trafficking” so all you PCVs pick a new method to get out of future regional meetings.
4. NIH sees less than 20 cases a year internationally of leishmaniasis.
5. The current global estimate implies an increase of leish outbreak due to global warming, climate change, and deforestation. There were 8 known strains and now there are 20.
6. The medical research team at NIH will treat me with an oral pill, 3x a day (called miltefosine) for 28-days and monitor my major organs for fun side effects like kidney failure.
7. My lesion (a really pissed off bug bite right about now) will maybe go away in a couple months and there will be very cool scar and hopefully an even cooler story.
8. There is no test to see if I am “cured” at the end of my treatment. I just get to keep an eye out for more Mike events for the rest of time.
If all goes well (and NIH believes so) I should qualify to return to service before my 45-day timer is up on March 26th. My next medical testing is March 5th and then again somewhere around the 19th.
As of publishing this post- so far so good on tolerating the super fancy NASA meds! I have a couple more days to let the half-life of the medication to fully on-board my system and start to work on giving Mikes a run for their amastigotes.
Try learning all this stuff in this post in Spanish while undergoing an un-anesthetized procedure with a razor.
Can’t wait to see where this bridge collapse takes me next week.
Vamos a ver.
Leaderboard: Kristin sent me a care package to her parents filled with everything I could love in her pantry drawer. The best kind of care package.
I will be stopping by KB’s parent’s house on March 5th and 19th.
(But I am really all set right now guys :D)
c/o Cynthia Belt
5 Carvel Road
Annapolis, MD 21409