Introducing Anthony Marston

Learning medicine sometimes feels like we’re also learning a new language with hints of Latin, Greek, and even some previously hidden treasures in English. How do you begin to decipher the polysyllable words that health care providers sputter off? Let’s use an example from yesterday’s approach to medical terminology workshop: gastroenteritis. A word that meshes nicely with my previous post on food…

Linguists, eat your hearts out:
Gastr/o/enter/itis
Gastro- for “stomach”
Enter/o for “intestine, usually small intestine”
-itis for “inflammation”

When you put it all together, gastroenteritis is inflammation of abdominal viscera, usually involving the stomach and small intestine. Months in advance of touching down in Kathmandu, we were warned that most North American visitors would develop gastroenteritis, a reaction to the food, water, and/or environment in Nepal. After all, the “flora” - the bacteria and other microorganisms that exist in Nepal at this time of the year - are different than the ones that we typically encounter back in Canada. Despite a battery of vaccinations including typhoid and Dukoral (cholera and some E. coli protection), we’re not completely primed to fight off these foreign invaders. [Enter gastroenteritis.]

Hearing that most of us would be affected, we thought that we would draw some experience from Agatha Christie’s work: “And Then There Were None”. In this mystery classic, ten guests are tricked into coming to an island and, one-by-one, they get knocked off the island. Parents, don’t worry, our 2011 guesthouse version doesn’t involve anyone getting bumped off. We were curious to see who would be affected by the wicked gastroenteritis that we were warned about and whose gastrointestinal system would be robust enough to endure the entire time.

I’m sad to say that I’m the first to be affected: the Anthony Marston of our tale. Last Thursday, Renee, Kiley, and I arrived at the domestic terminal of the Kathmandu (Tribhuvan) Airport when I realized that something just wasn’t right. I became very familiar with the facilities at the airport and had a diva moment where I wasn’t sure if I could board the plane (sans washroom by the way) for our quick 25-minute jump to Pokhara. We arrived without any close calls and walked through Pokhara’s calm streets to Fish Tail Lodge (see Renee’s post for more Pokhara details). A touch of vomiting, a dash of fatigue, and a spoonful of GI upset, but I made it through the day relatively unscathed thanks to Renee and Kiley who snatched an antibiotic (Ciprofloxacin) from the local pharmacy, refuelled me with digestives and Pringles, and rehydrated me with WHO-approved electrolyte solution.

With Cipro on board, I thought that I was in the clear. That I had had done my pledging with the dreaded combination of gastroenteritis and travel. I couldn’t be more wrong. I started to experience symptoms again on Monday evening and, unfortunately, wasn’t well enough to attend our first problem-based learning (PBL) session on Tuesday morning. I spent most of the day cycling between being a couch potato, sleeping, and frequenting the guesthouse’s facilities. It was one of my body’s weakest points – there were times when I could barely muster the energy to sit up; moving up and down stairs felt like doing the Grouse Grind. I had an incredible amount of support from the rest of the Health Trek team, CA didi, and even a personalized home visit from one of the administrators of PAHS. I started to recover yesterday morning, only to relapse again in the evening. I was so uncomfortable during the evening that I wasn’t able to sleep and watched the entire Hannibal series on a local movie channel. I don’t know if it was the best thing to settle an already tumultuous stomach, but it kept me entertained in the early hours of the morning. I finally decided to ask for some antibiotic advice when it felt like my abdomen had more pressure than road bike tires! CA didi and the PAHS team have been amazing – they quickly arranged a ride to a clinic at Patan Hospital and a visit with one of the physicians who didn’t seem too concerned about my current condition. A big thank you for all of you who looked out for me.

Fellow travelers, especially to Nepal, a few reminders that I wanted to share from my consultation today:

- Travel shots are a good idea, but don’t provide complete protection
- Be cautious about your food and water quality, but gastroenteritis can still occur with strict precautions
- Cipro is not the miracle drug that I expected it to be and can give you a false sense of security; because of its wide and sometimes inappropriate use, many pathogens have become resistant to it in Nepal
- Your travelling pharmacy should perhaps contain some of the following: dimenhydrinate, metoclopramide, loperamide, and some form of antibiotic coverage
- Worsening symptoms, blood or mucous in stools, and high fevers always need to be investigated further

Now, we wait and hydrate. I can’t wait to put this behind me and get back to work on the project. The next question is: Who will play Ethel Rogers in our tale? I certainly hope the novel comes to a surprising ending before Ethel Rogers plays her part.

And then there were five.