Travel Medical Issues

This is the third and final installment writing about my recent adventures and misadventures in Ecuador.  Before reading this article, get up to speed by reading Part One (Guayaquil) and Part Two (Montañita).

 

My Health Issues

 

After seven days in Ecuador, I woke up in my hotel bed soaked in sweat and feeling delirious.  I took my temperature.  It was 103.5 degrees.  I felt like shit.  Bad headache.  Horrible back pains and body aches. No energy.

 

I immediately thought “Covid.”  But then I started running through the symptom lists in my head.  They were inconsistent with a Covid-19 infection.  Besides, I had been vaccinated.  I had no coughing, no loss of taste or smell, no runny nose, no sneezing.  It’s difficult to diagnose oneself with a respiratory virus when one has zero respiratory symptoms.

 

Hmmm…

 

I had spent some extra time in the previous few days walking on the beach and in the nearby jungle.  I had half a dozen mosquito bites on my legs.  High fever and mosquito bites in a tropical environment makes me think of Malaria or another mosquito-borne virus like Dengue Fever, Chickungunya, or Zika.  I never thought I’d be saying this, but I was hoping for something mild like Dengue or Zika rather than dealing with Covid-19 in a developing country.

 

I actually caught malaria in Colombia back in 2012 (despite being on anti-malaria prophylaxis). What I was feeling in Ecuador didn’t match up with the symptoms I had when I was diagnosed with malaria.  The malaria risk was so low in the area that I was staying, I didn’t even pack my normal anti-malaria meds.

 

Since I was vaccinated against Covid-19 (J&J vaccine taken in April, 2021) and I had no respiratory symptoms, it couldn’t be Covid.  Probably some random jungle virus delivered from  a mosquito bite.  No problem.  I’ll rest up, stay hydrated, and be over it in a couple days.  I popped some Tylenol.  The fever dropped back to normal and my body aches were gone.  Cool.  I can manage this.

 

I continued my regular daily writing and activity.  I generally felt low energy.  The fever was constant (peaking at 104 degrees), but responded to Tylenol.  I had a horrible headache and had little appetite.  These symptoms continued for a couple of days.  After almost three days, I suddenly lost my sense of taste.  Now I was starting to think about Covid-19 being the likely cause of my illness despite being fully vaccinated.

 

As I am interested in keeping myself healthy, and given the fact that I teach austere medical training classes all over the country, I was fairy well informed about Covid-19.  I understood the current medical protocols for treating the virus and I also had read a lot about “alternative” Covid-19 treatments as well.

 

I knew about the I-MASK + Prototocols for using Ivermectin as both a prophylaxis and as a treatment modality for Covid-19.  From previous third world travels, I knew that taking Ivermectin didn’t cause any problems for me.  During all my previous pandemic travels, I had followed the I-MASK prophylaxis protocols and took a weekly dose of Ivermectin as a cheap insurance policy.

 

The studies about the drug were small in patient numbers, but showed potential.  I knew Ivermectin wouldn’t harm me.  It may help me avoid catching the virus.  That made it an easy choice for me to use during my travels.  I had been taking the weekly Ivermectin prophylaxis dose when I got sick.

I had packed a separate I-MASK+ bag of drugs just in case I got sick in a foreign country.  I dug them out of my med kit and began taking them.  The dosing protocols actually changed slightly while I was sick.  I was operating off of the earlier recommendations.  I immediately started taking Ivermectin daily at the .4 mg/kg of bodyweight ratio.  I also added supplemental zinc, quercetin, aspirin, Vitamin D, Vitamin C, and melatonin.

 

Worsening Symptoms

 

After a couple days with no relief, I started experiencing some serious shortness of breath.  I had a pulse oximeter in my kit and began checking my oxygen saturations when I found myself out of breath.  Pulse oxygen concentration in healthy individuals is usually between 95% and 100%.  Patients running under 90% are generally candidates for hospitalization.  There is even more danger when concentrations drop below 86%.

 

When I first started feeling short of breath, I checked my pulse ox and it was 92%.  That was from the seated position with no exertion.  As soon as I got up and started moving around, the pulse ox plummeted to 73%.  That wasn’t a good sign.  I needed some help.

 

 

The town where I was staying had no hospital or clinic.  It didn’t even have a practicing physician.  There was a tiny general medical clinic in the next town over, but it had very poor reviews.  The closest real hospital was about 90 minutes away.  The better hospitals were in Guayaquil, about three hours away.

 

Ecuador had some serious problems handling Covid patients a few months ago.  In Guayaquil, the bodies of Covid-19 casualties were literally dumped in the street.  I did some quick calculations.  About 30% of the Covid-19 patients who were admitted into the hospital in Ecuador died.  I really wanted to avoid Ecuadorian hospitals.

 

I also wasn’t sure about Ecuador’s quarantine laws.  I could get a Covid-19 test in the next town over, but I didn’t know the implications of doing so.  I was seriously worried that if I tested positive, I would be taken into custody and forced to quarantine in a sub-par Ecuadorian hospital.  I didn’t want that.  I would rather ride out the illness in my own hotel room than be forced into a quarantine hospital for in indeterminate time period.

 

I stayed in my room and hoped that my I-MASK+ drugs would carry me through.  They didn’t.  After a couple more days, my pulse ox was continuing to decline.  I had difficulty breathing whenever I so much as rose to a standing position.  Things weren’t going well and I needed some medical help.  I didn’t trust any of the local “help” I was likely to get.  I was completely on my own without any friends or family in the country I was visiting.

 

I began communicating with Roland Rivero, a friend who is both a SWAT doctor and an emergency room physician back in Ohio.  Rowland quickly disabused me of the notion that I had some minor tropical fever.  He recognized the Covid symptoms immediately and gave me some drug information.  Rowland instructed me to go to the pharmacy and get both oral corticosteroids (Dexamethasone 6 mg/day) and a steroid inhaler (budesonide).

 

Fortunately, there were a couple of pharmacies in town. I hit them up and was able to buy both the inhaler and the steroid pills.  It’s nice when the developing world doesn’t require a doctor’s prescription to buy drugs.  I walked unto the pharmacy and told them what I needed.  I walked out with a bag of pills and two inhalers.  It cost me $27.00 US.

 

I kept up with my I-MASK+ drug protocol, but added the steroids and the inhaler.

 

The Escape Decision

 

I figured I’d be OK in a couple days.  After all, I had been fully vaccinated .  Medical authorities stated that 99.5% of vaccinated individuals had “minor” symptoms if they ever caught the virus at all.  Either I’m really unique or the numbers our doctors and politicians are using are seriously skewed.

 

My “minor” symptoms just kept getting worse.  During the next couple days my resting oxygen concentrations were dropping to around 85%.  On exertion, they plummeted to below 70%.  I began coughing up blood.   Even on the drugs, I was in bad shape.  I wanted to ride it out.  Rowland convinced me of the serious nature of my condition and further convinced me to fly home to seek better medical care.

 

My previous plan was to ride everything out and fly back home once I was no longer contagious.  My difficulty breathing altered that plan.  I needed to get home to some real medical care before I died in Ecuador.  It was time to change my flight and go home early.  I changed my flight and planned to move to a bigger city for a day in case my symptoms worsened and I needed immediate local medical attention.

 

The problem now was the fact that I needed a negative Covid-19 test to get back in the country.  How could I do that when I was likely still suffering from Covid-19?  I booked a test from a lab in the next town over.  The lab staff stated that they would send a nurse to administer the test at my hotel.  I struggled to get down to the hotel registration area.  A taxi pulled up carrying a nurse wearing full PPE and carrying a plastic tackle box.

 

The nurse pulled out the Covid testing swabs out of her tackle box and jammed them up my nostrils right in the hotel lobby.  She took down my information.  I paid her $35 cash.  She stated that I would have my results delivered via the WhatsApp application on my phone within 90 minutes.

 

Sure enough, an hour later I got my test results via WhatsApp.  Of course I was positive for Covid-19.  Now what do I do?  It was a choice of risking my life staying in Ecuador or engaging in some fraudulent activities and flying home to get better medical care.  I didn’t want to spread the virus, but I didn’t want to die in Ecuador either.  It was a tough decision.  All I knew is that with my steady deterioration, I needed advanced medical care somewhere or I would most certainly be dead within a couple days.

 

 

You wonder why I didn’t just go to a hospital in Ecuador?  Have you ever been inside a hospital in the developing world?  Especially one that is completely overcrowded with Covid-19 patients?  No thanks.  If you want to read about third world medical treatment, read this Facebook account of catching Covid-19 in St. Lucia.  The author is a friend of some people most of you know in the tactical community.

 

Let’s talk a little about the negative Covid-19 test needed to get back into the USA…

 

As I wrote in the previous articles, I’ve traveled quite a bit during the pandemic.  On every trip, I’ve dutifully taken and passed my Covid test to get back home.  Other folks haven’t been quite so conscientious.

 

When I was living in Mexico earlier in the year, I met an actual medical doctor who would straight up falsify a letter with your negative Covid-19 test results for $150.

 

When I spent time in the Dominican Republic in February, the hospital staff giving me my Covid test commented that ZERO tourists ever end up with a positive test.  Under Dominican law,  if tourists test positive, the government has to pay for their quarantine.  The government doesn’t want to do that.  Thereby all tourists surprisingly get a passing Covid test to get home.  The hospital staff just laughed at how preposterous the entire system was.

 

In Costa Rica, the lab doing the Covid tests offered to date the tests whenever we wanted them.  It was all about the money.  For $100 you got a negative test dated whenever you wanted it to be dated.

 

I may be a bit jaded, but these experiences didn’t make me think that the USA’s requirement for a negative Covid-19 test on entry was all that valuable.  I wasn’t trying to fake my test results and still found lots of folks willing to work with me to make my  results look however I wanted them to look.  I determined that the Covid-19 testing requirement getting back into the USA was less than useless.  People who had the virus could get in effortlessly.  That analysis set the tone for my options on this trip.

 

There are two ways one could get back into the USA.

 

The easiest solution is that one could have a negative Covid test within three days of one’s flight.

 

Or, one could have a positive Covid test and a letter from a doctor explaining that you had recovered from Covid-19 and were no longer contagious (many people test positive for up to three months after recovering from the virus).

 

These documents are examined by the airline ticketing staff as you check into your flight.  In my experience, they don’t scrutinize such documents deeply.  If you have something looking vaguely official, they will accept it.

 

So how would one board a USA-bound flight if one were suffering from Covid-19?  Let me count the ways:

 

• One could bribe a testing lab for a clean test
• One could bribe the examining official for a pass despite a positive test result
• One could pay someone else to take the test for himself
• One could take an email denoting a positive result and change it to a negative result with Photoshop or a word processing program
• One could fake a letter from a local English-speaking doctor stating that one was recovered from Covid-19

 

As an admission to one of these tactics might be a crime, I’m not going to tell you how I got on board the flight, but it wasn’t difficult.  The documents were the least of my worries getting out of the country.

 

The Escape Process

 

The problem wasn’t the documentation.  The problem was that I was deathly ill and didn’t want to be forced into an Ecuadorian quarantine hospital.

 

As I was the only person staying at my hotel, I was worried that word would get back to the manager about my positive test.  I immediately checked out of that hotel and booked a taxi back to Guayaquil.  That put me in the same city as the airport and gave me some medical support should I need it before I left.

 

I changed my flight.  I booked a business class seat home.  On all my connections I chose a single seat aisle along the window.  That kept me as far apart from people as I could possibly be on the airplane.  The business class booking also allowed me to hang out in the airline lounges between flights.  In the lounges, I was able to find isolated places far away from other people to minimize my chance of spreading the virus.

 

The flight home was 13 hours including three connections.    The challenge would be navigating all that while I couldn’t breathe and was running an oxygen saturation of less than 80%.  I knew if I made it to Miami, I’d be OK.  The problem was that Florida had far more Covid-19 cases than Ohio.  My hospital care in Miami wouldn’t likely be as good as I would get if I could make it all the way home to Columbus.  Columbus was the goal, but if I was dying, I’d get medical attention in one of my connecting cities.

 

The first step was appearing well enough to board the plane in Ecuador and making it through their customs and immigration checks without triggering medical intervention.

 

I got up in the morning and took every drug in my med bag.  My goal was to minimize all my symptoms in order to make me appear healthy.  I also wanted to eliminate my coughing, sneezing, and nasal secretions in order to reduce the chance that I might infect someone else.

 

I took:

Dexamethasone (steroid)

Budesonide inhaler (steroid)

Tylenol Cold and Flu (cough suppressant, fever reducer, antihistamine, decongestant)

Advil (for body aches)

Loperimide (for diarrhea)

Modafanil (a prescription cognitive enhancer to fight the Covid-19 “brain fog.”)

Caffeine (more mental alertness)

 

I breezed through the Covid test document exam, luggage check, and immigration.  I made it through security and set up at my gate as far away from other people as I could get.  I boarded my plane last and passed out until I landed in Miami.

 

Upon landing, I checked my pulse ox.  I was running in the low 80% saturation.  That wasn’t good.  I had to look well enough to get through USA immigration and security again.  Fortunately, I had Global Entry.  I went through the expedited line and handed my printout to the border patrol officer.  He asked “Where are you coming from?”  I replied “Ecuador.”  He said “Welcome home” and waved me through.

 

I cleared security, rechecked my bag, and waited in the lounge until my next flight boarded.  I was hurting.  I slept again on the flight.

 

As I was disembarking the plane, I collapsed.  I fell to the ground right at the end of the jet bridge and was unconscious a couple seconds.  My oxygen was at 70% and I couldn’t breathe.  A couple people helped me to my feet.  I played it off like I had lost my balance and quickly found a chair.  I rested until my oxygen levels rose and then I found my way to the gate.  My phone step counter said I had walked more than three miles already that day.  That was too much with only 70% oxygen saturation.

 

I finally made it to Columbus, got my bag, and drove home.  I packed a quick overnight pack and drove to the closest hospital emergency room.

 

 

The Hospital

 

I walked into the hospital ER.  There were no other patients ahead of me.  I explained to the nurse that I had tested positive for Covid-19 and was having difficulty breathing.  She checked my oxygen and found that it was 77%.  They immediately admitted me and gave me six liters of oxygen via nasal cannula.  That helped.  Within a few minutes, my oxygen levels were floating around the 88% level.

 

I was lucky.  There were no signs of organ damage, embolisms, or blood clots.  If I could get my lungs working again, I would be OK.

 

 

They took CAT scans of my lungs.  The doctor showed me the films.  It was staggering.  The CAT scans looked like both of my lungs were completely filled with broken glass.  The diagnosis was double Covid-19 pneumonia.  I would need steroids, anti-virals, and oxygen until my lungs healed up and started working again.  Fortunately, I responded to the nasal oxygen and didn’t need to be intubated.

 

I had an excellent infectious disease specialist working on my case.  She quickly set some goals for me in order to be released while simultaneously developing a plan if I were to take a turn for the worse.  It was going to take some time for my lungs to heal.

 

The doctors prescribed:

6mg/day Dexamethasone (10 days)

daily Remdesivir IV infusion (anti-viral)

daily Lovenox injection (to prevent blood clots)

a decongestant

a cough suppressant

B-vitamins and melatonin

 

As I entered the hospital on the 10th day after having symptoms, I wasn’t eligible for monoclonal antibody therapy.

 

I ended up spending six nights and seven days in the hospital until I could breathe well enough that I could be released.  I had excellent care in the hospital (Ohio Health Dublin Methodist) and want to thank Dr. Solaiman, as well as nurses Kerry, Alex, and Hanni for taking such good care of me while I was so sick.  I have absolutely no complaints about my hospital stay.  All the staff were incredibly caring and compassionate.  If I ever get sick again, I’m heading back to the same hospital.

 

As of today, I’ve been home for a week.  It’s been 24 days since my first symptoms.  I’m still using supplementary oxygen (two liters) when I sleep and occasionally during the day after periods of high exertion.  My numbers are gradually improving every day.  My pulse ox at rest without oxygen is running 92-94%.  When I exert myself, it drops to 84-86%.  Even the lightest gym workouts are exhausting.  I get out of breath after walking up a single flight of stairs.  With that said, I’ve been hitting light gym workouts every day since I was released from quarantine.  I walked three miles straight without oxygen over the weekend and was OK other than feeling slightly short of breath.  I’m feeling pretty good, but it will probably take a few more weeks until I get back to some semblance of “normal.”

 

Shockingly, I lost exactly 30  pounds of body weight during my ordeal.  The Covid-19 diet worked amazingly well!  As I regularly monitor body fat skin fold measurements, I had data on my skin folds and measurements from just before I left for Ecuador.  I repeated my measurements after I got home from the hospital.  Of the 30 pounds I lost, 26 of them were muscle.  Ouch.  It’s going to take a while to rebuild that amount of muscle mass.  I probably shouldn’t complain.  Being scrawny is a better alternative to being dead.

 

Final thoughts on Covid-19 Vaccines, Countermeasures, and Treatment

 

Below are my personal thoughts after surviving this ordeal.  I hate politics.  I distrust the government.  I am not a doctor.  Take my advice with a grain of salt.   I’m not going to debate anyone about my conclusions.  I won’t answer any inflammatory or political messages that some of you may send me after reading this.  This my own little N=1 experiment.  I’ll share my results in the hopes that they might help some of you in the future.  If you disagree with my approach, stop reading.  It’s that easy.  Life is too short to spend a minute arguing with strangers of the internet.

 

Fair warning.  Here we go.

 

According to the CDC, “The incubation period for COVID-19 is thought to extend to 14 days, with a median of 4-5 days from exposure to symptoms onset.”  My symptoms began on my seventh day in Ecuador.  While it’s possible I could have caught it at home, I think it’s probably more likely that I caught the bug in Ecuador.

 

Although they didn’t test for which variant I had, my docs seem to think that I was one of the early USA Lambda infections.  Lambda is more prevalent in South America than Delta.  Delta infections are also almost universally associated with respiratory issues.  I didn’t have any of those other than shortness of breath.  Lambda’s ability to infect the fully vaccinated makes sense in my condition as well.  It’s probably Lambda, but no one will ever know.

 

Given the time frame, I likely caught the virus in Ecuador.  Ecuador has a mandatory masking law in all public locations.  I adhered to that ruling without exception.  Before my viral symptoms, I wore a mask 100% of the time in all public locations except when I was eating or drinking.  I ate all my meals except the hotel breakfast outdoors.  I used a surgical mask rather than an N95.  I’ll let you draw your own conclusions about how effective (non-N-95) masks are at preventing acquisition of this virus.  I wore one every time I was in public and still caught the ‘Rona.

 

 

I studied the Ivermectin research.  I was on the prophylactic dose when I got sick.  I bumped my ivermectin to the daily “high dose” regimen once I had my first symptoms.  I followed the I-MASK+ protocols for nine days.  The Ivermectin did absolutely nothing for me.  I won’t be taking it again.  Nor would I ever give you folks the advice to use it if you get really sick.

 

While some of the research write ups on Ivermectin look promising, we all have to keep things in perspective.  There have been formal ivermectin studies done on about 20,000 people across the globe.  Since the pandemic began, we’ve seen more than 210,000,000 worldwide cases.  Put things in perspective.  Even if the ivermectin study results look great, they really only cover a tiny fraction of a percentage of the world’s sick people.

 

I think it’s probably safe to say that ivermectin won’t hurt you (so long as you dose correctly). but it’s unlikely to help you either.  I have some friends with anecdotal personal experiences that make them very much in favor of using the I-MASK+ protocols on every patient.  I think the folks reporting that they suddenly “got better” after taking ivermectin probably had mild versions of the disease and would have likely gotten better quickly no matter what they had done.

 

I’ll reiterate my experience.  I took Ivermectin both as a preventative and as a treatment modality.  The ivermectin had no effect on my infection.  Despite taking it, my condition degraded steadily and I ended up in the hospital for a week.  I don’t want to burst your bubble, but if you are depending on ivermectin stockpiles to save your family. you may be very seriously disappointed.

 

With regard to my treatment in the hospital, I received the standard of care that is supported by the most rigorous scientific evidence developed thus far in this pandemic.  I probably got more than 100 messages during my ordeal instructing me to DEMAND that my doctors put me on some weird drug, herb, vitamin, or exercise protocol that may have been helpful for someone else.  It was incredibly frustrating.

 

People who have never even had the virus were writing, calling, and texting me with instructions for me to tell my doctors that I would be leaving if they didn’t provide me access to some weird-ass drug or treatment protocol.  Sure, I could check myself out of the hospital in protest that the docs won’t give me some experimental drug, but where would that get me?  I’m not going to threaten my doctors or try to leave the hospital when I can’t yet breathe on my own.   Some of you are absolutely ridiculous.

 

That’s not how this works, folks.  It’s like demanding my doctor give me a years’ worth of Percocet for a sprained ankle.  It’s  just not going to happen.  Although I value your desire to see me pull through this condition, giving me medical advice based on the YouTube conspiracy video you watched is not going to help me.  Please, if you haven’t suffered through this virus yourself, don’t think that you could possibly be in a position to guide a friend’s medical treatment based on the latest YouTube conspiracy video.

 

Just stop.  You aren’t helping.  Shut up and help your friend get better.  His/her doctors might know a bit more about the topic than you do even if you’ve done all your YouTube and Google “research.”

 

With regards to the vaccine, I’m still not sure what to think.

 

I wasn’t really worried about catching Covid-19.  I’ve traveled all over the world during the pandemic with nary a sniffle.  Before I retired, we handled all the Covid-19 dead bodies and dealt with sick folks without any PPE gear every day.  I even helped doing CPR on a Covid + victim and I didn’t get the virus.  I’m healthy and don’t generally get sick.  Covid didn’t scare me.

 

I got the vaccine because I thought it would eventually be mandatory for international travel.  I chose the J&J vaccine because it was the simplest to administer and the fewest side effects.

 

I’m tempted to think that the vaccines are almost useless.  I was fully vaccinated and ended up spending a week in the hospital!  It doesn’t make me think highly of the vaccines’ effectiveness.  I was one of those “breakthrough hospitalizations” that many news outlets claim is almost impossible.

 

Tempering my desire to think that vaccination is useless is the information I received when I was in the hospital.  I talked to all the doctors, nurses, phlebotomists, cleaning crews, and technical staff that came into my room.  I asked lots of questions.

 

Without exception, the medical staff said that I had made the right choice getting the vaccine.  Even though I had to stay in the hospital for a week, the docs and nurses were convinced that I would have been far worse off had I not been vaccinated.  I tend to think spending a week in the hospital is a bad outcome.  But if I compare that to spending several months in the hospital on a ventilator, it doesn’t seem so bad.

 

Every single staff member I talked to stated that the people who were vaccinated in the hospital were doing much better than those who had not been vaccinated.  I have a good “bullshit detector.”  I can tell if the medical staff has been ordered to parrot the “company line.”  I did not get that impression here.  All the doctors, nurses, and techs were incredibly candid.  They seemed honest and helpful.

 

When every single one of those folks who have been treating Covid patients for 18+ months tells me that the vaccinated people have fewer problems than the un-vaccinated people, I tend to pay attention.  The nurses told me some absolute horror stories.  There were two 19-year old unvaccinated guys in the room next to me.  Both were on ventilators when I arrived.  Both were still on ventilators without any improvement when I left.  It’s scary stuff.

 

I don’t care if you get vaccinated or not.  I was pretty ambivalent about the whole issue until I ended up in the hospital.  My experiences thus far have made me decide to seek a booster shot when my natural/vaccine immunity starts to fade.

 

Thanks for indulging my stories about this crazy virus.  As I said before, I have no desire to debate anything about my experience with any of you.  I hope you found the information I provided to be useful.  I pray that you all are able to stay healthy and avoid this nasty affliction.