SARS update, fear in Asia, and yes, doc is really a doctor and doesn't just play one on TV....

It's a bit crazy here in Asia now. The fear factor with respect to this SARS stuff is really quite high. But first, maybe a definition is in order. Direct from the Center of Disease Control, the latest dictum on SARS:

March 28, 2003

The U.S. Department of State encourages American citizens traveling or residing abroad to familiarize themselves with the information available from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) about Severe Acute Respiratory Syndrome (SARS). This Fact Sheet updates the March 21, 2003, version and reflects changes in the geographic spread of SARS cases and includes additional information.

In Hanoi, Vietnam and Hong Kong, the appearance of SARS has had an impact on medical facilities, due to the closing and/or quarantine of hospitals and the spread of the disease to health care workers. Medical evacuation of SARS patients currently is not available by commercial carrier; additionally, the number of countries willing to accept SARS patients is very limited.

Prospective parents of adoptees from mainland China and Vietnam should consult the appropriate link on adoptions at the CDC website

In addition to Vietnam, Hong Kong, mainland China and Singapore, the CDC has received reports of outbreaks of SARS elsewhere in Asia and in Europe and North America, including Canada, the United States, Thailand, Germany, and Switzerland. Most cases appear to involve health-care workers caring for SARS patients and close family contacts. CDC is working closely with WHO and country partners to define the origin of this infection, to track patterns of its transmission, and to determine effective strategies for its control and prevention. Local health authorities should be notified of all suspected cases of SARS.

The CDC has identified the following three criteria, which must ALL be present, by which a potential SARS case may be identified, for those with the onset of illness after February 1, 2003:

--Fever greater than 38° C (100.4°F), AND
--One or more signs or symptoms of respiratory illness including cough, shortness of breath, difficulty breathing, hypoxia (low oxygen in the blood), x-ray findings of pneumonia, or respiratory distress, AND

-- One or more of the following within 2-7 days of the onset of symptoms: Travel to mainland China, Hong Kong, Singapore, or Vietnam; and/or close contact, with a person who has been infected with SARS (close contact means having cared for, lived with, or having had direct contact with respiratory secretions (such as coughs and sneezes) and body fluids of a person with SARS).

The incubation period between exposure to infection and the development of symptoms appears to range from 2-7 days. For more specific information regarding case definition updates and empiric treatment clinicians should consult and monitor the CDC's and WHO's web sites.

Currently, prevention of new cases is based on individuals avoiding close contact with SARS-infected persons, as described above. Persons matching the case description for SARS should be promptly evaluated by medical personnel and, if indicated, admitted to a hospital. Persons suspected of having SARS should limit their interactions outside hospital settings.

Well, according to their guidelines, I had it. And, my little Beijing honey also had it, getting it directly, within hours, from yours truly. And Yong, also got infected with some sort of flu, but he didn't have difficulty breathing associated with it. In fact, contrary to what the Chinese government was telling the world at the time, from my observation of people in Beijing, some sort of flu like illness was rampant. China is just now admitting that it has more SARS cases than it first said. Typical Chinese government behavior. Smoke and mirrors.

Regardless, some high dose Zinc Sulfate, Vitamin C, and Ceclor, plus two weeks in the sun in Thailand, and I was mostly over it. I got out of China and into Thailand just in time. For last week the fear factor got notched up quite a bit, and Thailand started implementing some pretty serious quarantine measures:

-All people traveling from China to Thailand must now undergo mandatory 14 day house arrest.
-All suspected SARS cases found at Thailand's international airport are automatically sent for quarantine to one of the old leper colonies.

Had I arrived last week, instead of two weeks ago, with my cough, I probably would have been put away for a bit. But, except for a slight residual cough, I'm over it.

The local economy is really paying for it though. Airlines that fly in and out of Asia are cancelling flights right and left. Quarantine efforts in various international airports that deal with passengers from Asia have been ramped up. I have no idea what "going home" is going to be like at this point. I've decided to stay in Thailand for a little while longer, knowing damn well that this virus, and the widespread fear that it has caused, will burn itself out sometime in the near future.

And we had our first death here in Phuket from SARS. A tourist from Singapore. Got off the plane, ended up in the hospital the next day, died two days later. The Thai people are not too happy. The Thai government needs to be commended on their actions to tighten up the health security of their people, but, they're telling the local populace to not congregate in public, has caused the shopping malls, supermarkets, and movie theaters to empty. People avoid groups. People avoid congregating in closed areas. Everybody avoids the Chinese. If, you see any of them at all. It's actually a bit frightening in one sense; I noticed it when I first came here, how people would step back away from me, when they saw me cough, but to go into a public place, like a movie theater, and find few people in there, it's really kind of bizarre. Kind of reminds me of that Charleton Heston movie from a while back, The Omega Man. Everybody is so fearful. And oh, the movie Chicago is really pretty damn good. I especially liked Richard Gere, an actor who I was not too happy with after the hamster episode. Good actor, but just can't seem to forgive him for that one.

Stupid is as stupid does, and yes, doc is a doctor...

But sometimes you wouldn't know it. My latest foray into the world of illness, and god knows I've had nothing but since January 2003, was a trip to the Intensive Care Unit here in Phuket. Yes, Phuket has a hospital. A rather nice one at that. With young doctors that really didn't seem to generate a whole hell of a lot of confidence. But, it was all I had, and fortunately, upon hearing that I was a physician, they basically let me guide my own care.

Nice caring people, these Thai. I truly love them.

But old doc really fucked up the other day. Truly fucked up. He should have known better. Listen and learn from the errors of my stupid and idiotic ways.

As my lungs cleared up last week (this time from SARS, and not from allergic asthma), I started training in Muay Thai. Started swimming, started lifting a little, just, took it easy. Tried to ramp up my physical abilities after three horrible months of recurring physical disasters, and absolutely no gong fu training. I slowly started to build up my strength again, and by Friday of last week, I was really starting to feel better. The workouts got more intense, which just resulted in my getting more dehydrated. Well, I've always used water to rehydrate myself, and, in the Asian climate, always added a generous amount of salt and bananas to replace the lost electrolytes. But Friday, Friday was different.

I was feeling good after my work out, and decided to drive down the coast to some restaurant which overlooked the Andamann sea. Because I was suffering from one of my horrendous (but thanfully, infrequent, here in Phuket) migraines, I drank some Coke during lunch. And because I was dehydrated, I had another one. And another, And after a while, I forgot how many I had. But, I was feeling better; my head was improved, but by gut was a bit distended. Too much soda, too much gas. I decided to take it easy that afternoon, and we spent the time just driving around.

Nang got hungry a little later, so we stopped at a favorite little French place to get some dinner. Of course, the mandatory lemon juice soda was in order; in fact, it was so good, I had a whole bottle. With dinner done, we headed back to the hotel.

A little bloated and distended from all the soda I had that day, I decided to go to the pool to swim some of it off. It really was no problem, though, five minutes after getting out of the pool, I started to feel lightheaded, with some epigastric distress, and palpitations. I didn't think much of it, though I didn't like it, and I decided that the best thing to do was to go to bed.

Laying down seemed to aggravate the belching that I was suffering from. I knew that I had too much bloat from all the carbonated drinks I had imbibed that afternoon. But the epigastric pressure just did not want to go away, and the ever worsening lack of strength, and lightheadedness, just seemed to increase. I took some antacids to combat the gas, but, the Pepto that I bring with me to Asia (to combat the local beasties in the food and water), didn't have any simethicone, which destroys gas bubbles. I had the wrong antacid for what I was trying to accomplish. No matter, a little bit of time, and it would all wear off. Or so I had thought.

That's when I noticed my grossly irregular pulse. That, with the fact that my hands were getting ice cold because of lack of perfusion, was enough to cause me to get a cab to the hospital. By the time I reached the ER, I was pretty weak and lightheaded, my pulse was still erratic.

They took me right in; an EKG revealed that I was not suffering from a heart attack. Nor did it capture any of those irregularities (the scan time is very short with this modern equipment). I explained to the rather young ER doctor what I had done that day, and questioned whether getting into the pool redistributed some of the gas in my intestines to my stomach, causing an acute gastric distention, with a resulting vagal response that was slowing my heart down to intolerable levels. He seemed to agree with me, and approved my request for a different type of antacid, one with simethicone.

I told him that I had wanted a complete cardiac workup anyway, just to make sure that we weren't missing something, which he had agreed to. I ended up in the ICU for the night for monitoring and further tests, all of which came back as normal. I left the next morning, got Nang who was sleeping on the street outside waiting for me (God bless her little Thai heart), and returned back for a few days of rest at the hotel.

All because of too much soda.

The heart has two halves, the left half pumps blood from the lungs to the body, the right half pumps blood from the body to the lungs.Each half has two halves, a top (atrium) and bottom (ventricle). The bottom half is responsible for most of the pumping action, the upper half, just "tops off" the ventricle prior to its contraction, and pressurizes it, so that good proper pumping action occurs. With the loss of the atria's contractions, the ventricles do not pressurize prior to their contraction, and the output of the heart (the cardiac output), can get seriously diminished.

When you have acute gastric distention, you can get a body response, called a vagal response. The vagus is a nerve which is a major part of the parasympathetic nervous system; it basically regulates body functions downward, for sleep, for digestion, for rest. It's counterpart, the sympathetic nervous system, basically regulates body systems upwards, increasing heart rate and awareness, for things like fighting, running, fright, etc. When you have increased vagal stimulation, your heart slows down. When you have a lot of vagal stimulation, the heart slows down to the point where the atria rarely contract. In this case, the ventricles, with their own little pacemaker system, take over, but at a greatly reduced rate. This is what happened to me; my heart slowed down to the point that my atria rarely contracted, and my ventricles, trying to take over, beat at a slower and more ineffective rate, to keep me alive. Had I truly had heart disease at that moment, I could have suffered an heart attack, or worse.

It was not the best experience I've had, especially in light of all the other shit I've been through this year. But, a lesson is to be learned from my stupidity.

Don't swim after you eat.

Oh, and rehydrating with soda is really not the best thing to do either.

Mother always seemed to know best, didn't she. Maybe one of these days doc will too.


(Continued in Shaolin 5/2003)