If you can only contract malaria in the tropics then it would only make sense that I would not get malaria in a place where the temperatures are hovering around -20C with wind chill to -50C. So if I come down with malaria at home during the sub-zero winter it is because I got infected by the malaria parasite sometime before I left Nigeria. Once bitten by the parasite carrying (vector) mosquito my body provides a warm, moist and safe place to travel worldwide and prosper. For the parasite to die I would have to freeze to death and I wasn’t planning on letting that happen.
I left Nigeria in early January and got home to one of the two worst winters on record. I spent an extra night in Toronto after many of the flights were cancelled because of the severe weather. Toronto Airport even shut down for half a day when the outside ground support workers claimed that -20C was too cold to work. The ground workers in Winnipeg work at -20C or below for most of the winter. It is what you get used to. In Fairbanks, Inuvik or Iqaluit they have to deal with -30C on regular basis and only shut down when the temperatures hit -50 or -55C. That is when turbine or jet engines can no longer start or operate safely. Piston engine aircraft are usually shut down around -32C.
Despite the -20C when I got home I went out the next day to snow blow our driveway. Holly had been doing it since November so it was my turn to give her a break. I spent several hours outside working the Honda snow blower and shoveling. When I come in the house my clothes were heavily soaked in sweat. My parka weighed 10lbs heavier than when I started.
The next morning I woke to aches and pains in my muscles and joints. My joints felt like someone had spent the night clobbering them with a rubber mallet. I had a headache at the top of my spine below my skull which was more than I would normally get from polishing off a bottle of Argentinian Malbec the night before. At breakfast I didn’t have an appetite and could not finish the Latvian Piragi (bacon buns) my mother had made for me over Christmas. I knew if I did not have an appetite for bacon buns I was definitely not well.
In fact I was a bit nauseous. Having jet lag and a mild hangover did not help and I could not rule out having come down with the flu. It had been going around with my mother and brother-in-law having just recovered. I might have picked it up across the Atlantic. I would normally have had a flu shot already this time of year but I had not been anywhere I could get the shot. So I did not want to rule it out. I could also blame the fact that I was out of shape and the hard work of manhandling the snow blower for nearly 3 hours could have just made my muscles stiff and sore. But since neither malaria nor the flu (or an hangover for that matter) can be treated at my local clinic I decided to self diagnose, by ignoring all the other “what-ifs” and self-treat for the worst case scenario.
I always pack several boxes of Novartis’ Coartem (artemether/lumefantrin) in my carry-on luggage whenever I travel and deposit an extra package at home. The shelf life is 2 years so I keep track and replace the package as required. Whenever I get the symptoms, starting with a dull to sharp pain at the base of my skull, aches and pains in my muscles and joints, chills at slight temperature changes, I immediately start the treatment.
My philosophy is that, since there are no side effects with this type of medication, I might as well treat myself for malaria just in case. If I have the flu then there will be no noticeable change. If I have malaria I will start to get better within 24 hours. That is how I know if it is one or the other. With the flu I will be sick for weeks not just days and recovery will be slow.
In fact if I did have malaria the type of drugs taken to lessen flu symptoms can mask the malaria symptoms and leave the treatment until it is seriously late in the development cycle. Therefore, at the first sign of the flu I treat for malaria. No harm no foul.
There are a lot of myths about malaria and I have heard them all. Since I have suffered from this malady 18 times now, 14 times lab tested and confirmed and 4 times where the treatment proved it could not have been anything else, I should be some kind of expert (of symptoms and treatment obviously not of prevention) by now. I quit taking malarial chemoprophylactics, however, partly because most of them had serious side effects on me.
Fansidar (sulfadoxine) gave me soft-body-part liaisons (don’t ask although 15 years later I still have purple spots in strange places) and nearly stopped my breathing – Larium (mefloquine) gave me hallucinations while I was flying (don’t ask although I am still not sure those green water spouts with arms and legs marching over the rain forest weren’t real.) One of the side effects from Canada’s personal favorite, Malarone, (atovaquone/proguanil) is that it leaves holes in my pocket at $5 per pill.
A skeptic may ask, isn’t the $150 per month worth missing out on the pain and suffering that comes along with malaria? No, but not because of the cost, but because prophylactics are not fully 100% guaranteed to prevent malaria outbreaks with long term exposure.
Malaria is an opportunistic parasite which thrives on a weakened system. In my case the preventatives have, on occasion, masked the symptoms to the point I thought I only had a mild headache for which I took Advil to get through my day. During the first phase of development the malaria parasite hides in your liver cells because neither your immune system nor preventative medicines can find it in there. It reproduces in your liver and gains strength until it is ready to emerge at any opportunity.
The opportunity comes when your body is under stress from any of a number of maladies: the flu, Typhoid, Cholera, jet lag from a long distance flight at airline altitudes, scuba diving to 30 meters or, in most cases I have witnessed, a severe self induced alcoholic hangover. The prophylactic prevents the outbreak but doesn’t get to the source allowing the malaria parasites the opportunity to go into the second or even third cycle of reproduction.
When your immune system has been weakened it eventually gets so overwhelmed that within hours you can go from a functioning, although slightly hurting, social animal having a few drinks at a party into a comatose casualty suffering bone chilling muscle tearing shivering that cannot be stopped even with multiple blankets or hot showers to severe bouts of fever that drench your sheets and mattress in a caustic smothering sweat.
At this point you cannot get out of bed to get your Coartem or Malarone even if it is on your bedside table. If it’s too late your body won’t let you. If its not too late your mind won’t want to. Your arms and legs retract into the fetal position and your fingers and toes curl from severe muscle spasms. Have you ever had a Charlie horse? Try imagining that all over your body. The pain is spine wrenching.
If you don’t get treatment within hours the parasites will devastate your red blood corpuscles releasing debilitating toxins and you will lapse into convulsions, shock, unconsciousness, coma and organ failure or even brain failure from what they call cerebral malaria. With up to 1.2 million deaths each year this is not a disease to take lightly. I have been in the initial stages of a coma 2 times where I was only saved by a quick chloroquine injection from a savvy doctor, and once in a hotel in Denver where I knew I had to force myself to get up to take the pills or I would die in my bed. In a few more hours I would not have been able to take the pills orally and no one would have found me until later that day.
A fellow pilot had something similar happen to him in Wichita, after flying in from Nigeria. The hotel room maid only found him when the flight school reported him missing and he would not answer his phone. They got him to the hospital but didn’t test for malaria. After they contacted his wife, who told the doctor he had been in Nigeria, they waited for the malaria test results before ordering the “right” type of medicine. It came too late and he died of cerebral failure.
Therefore I don’t take preventatives. I pay attention to the signs and carry the treatment with me where ever I travel. I’d rather know what is coming and if I have the symptoms I take the pills. If I am somewhere I can get tested quickly, within 2 hours, I will delay the treatment until I can get tested but I don’t wait for the result. By the time the test result comes back it may be too late. The test doesn’t change anything anyway, but it’s good to know for sure. Once you take the treatment, however, there is no point getting tested. The test result will be negative. All what I have said, however, does not constitute advice. I have been an expatriate in malaria ridden areas for nearly 30 years so I have my own system for survival. For short term travellers I strongly advise to take Malarone as a preventative and take it as prescribed.
The biggest myth about malaria is that once you get it the cycle keeps coming back. That is only true if you don’t get treatment or if the treatment is inadequate. There is at least one strain, Plasmodium vivax, which can hide in your liver so efficiently that normal treatments, that kill all parasites in your bloodstream, will not prevent an eventual reoccurrence. There is a treatment, primaquine, which will get into your liver and kill all the parasites thus making the myth of malaria-for-life busted. In all the cases of malaria I have had over the years I have been able to pin point a spot where I had been bitten by a mosquito 7-14 days before. Don’t get bitten by a tropical plasmodium mosquito and you won’t get malaria. Simple as that.
The end result for my 18th malaria breakdown in -50C weather was one day of aches and pains, one day of chills and fever and one day of napping on the couch. I was planning to take a few days rest anyway so it was time well spent. At least I had an excuse to be a lay about for a few days while my wife got back onto the snow blower.