When I sliced my toe on a rusty grate during last year’s Lunar New Year fireworks, I refused to check on what had happened, opting instead to breathe through the burning and the pain, choosing pyrotechnics over inspecting the damage. After the light show ended, I stumbled down to my friend’s apartment to examine the injury. The grate had pierced my toenail and then cut diagonally across the side of my toe, necessitating a tetanus shot and much limping, but thankfully no stitches.

My Vietnamese friends were aghast.  The local beliefs surrounding Tet, Vietnam’s Lunar New Year, include the fact that what happens around midnight on Tet eve predicts and dictates the tone and spirit of your coming year. This is why, as I noted in my long roundup from last Lunar New Year, the person who crosses the threshold into a person’s house at midnight must be compatible with the new year’s astrological sign.

My Vietnamese friends urged me to take care during this Year of the Snake and they predicted that it would be fraught with health issues. After all, it started badly, with an inauspicious blow to my general health (and my toe). Business-wise it could be a success, they insisted, but in terms of personal wellness they were worried.

I laughed it off. It wasn’t out out of condescension that I dismissed their claims — after all, they are similar to my dad’s belief that the shape of our Christmas tree forecasts the mood for the coming year — but because I’m no stranger to foot injuries. When I climbed Agung and Rinjani in Indonesia in 2009, I lost several toenails and much of the skin off the back of my heel. Plus, I’m also fairly clumsy. I’ve been known to walk into walls when not looking, to trip over sidewalks, to have an alarming amount of near-misses over the course of my life.

But my friends were unrelenting. This injury was different. This was a harbinger of a trend for the coming lunar year. I would, they asserted, anxiously await the day that the Year of the Snake was over.

They were right.

Tet fireworks in Saigon for the year of the snake. Not pictured: bleeding toe.

Some of my Dengue Symptoms

I have tried to avoid writing about myself other than in the abstract here. I love sharing what I eat, and learn, and the stories of food and people involve me in some way as it is a personal blog. But there is a reason that I only do the state of the union -style posts once a year, or rarely delve into more personal issues: I don’t want this site to be a place where I whine or rant. I want it to be a place where people can learn through food.

So it is for this reason that when I started losing clumps of my hair in late February last year, I never wrote about it, nor shared updates on my Facebook page. And a month later when I stopped being able to bend my hands or knees in the morning without considerable pain, or look at bright light, I didn’t mention that either. I kept up my usual schedule in Vietnam, exploring the Mekong and surrounding regions and walking around town for hours a day.

In May, after flying to England to visit my brother, I could barely walk down the street without feeling exhausted. Alarmingly, when my leg or arm was itchy and I scratched it, I’d develop lines of bruises, colouring the spot where nails had met skin. As the summer went on and my existing obligations and plans were ticked off the list — conferences, meetups, interviews and more — I found myself getting sicker and more tired. My immune system was just not cooperating with anything I did; every cold or virus seemed to latch onto me stubbornly, and most of my days were obfuscated by a cloud of exhaustion.

Doctors were fairly unhelpful. One suggested that I was just stressed. As a former corporate lawyer I was pretty intimate with high stress situations, and I certainly was not stressed. Well, except about the fact that my health was deteriorating. Which, I think, was pretty reasonable on the spectrum of Events to Stress About. In actuality, the pain and hair loss had started at a time when I was the least stressed in decades; I was in Vietnam, loving my exploration of the city and its soups. Another thought I had lupus, and to be fair many of the symptoms lined up, but blood tests gave no indication that I might have it — back to square one.

In August, I took friends up on their offer to housesit during their honeymoon, staying in San Francisco and exploring, and trying to rest. Notwithstanding some up days, my joints were, for the most part, worsening. I kept up my tradition of climbing a mountain for my birthday, but for two weeks after my day in Mount Tamalpais, I had trouble getting out of bed because of the pain. Not knowing what was going on with my body coupled with the consequences of my decision not to share anything here or on social channels converted the chronic pain into a more anxious place; I was actually getting stressed. And I was having trouble explaining to people who wanted to meet up that I couldn’t, because based on my outward-facing social streams, no one would have thought I was having trouble bending my hands in the morning.

Golden Gate Bridge on an August day.

I confided in my close friends, all of whom were extremely generous with time and hugs, and who stretched their arms wide to pull in connections from their broader networks in the hopes of helping me figure out what was wrong. I was introduced to, and corresponded with, a woman whose many symptoms led her to cut out significant amounts of foods from her diet and completely change the way she lives her life in an attempt to keep her pain under control. I met a gentleman at a conference who had similar health issues while trying to grow a successful startup, leading him to temporarily walk away from his company while he focused on getting better, a terribly tough decision to make. Before doctors had ruled it out, I was connected to a woman had lupus, who shared coping strategies and foods to avoid. And I was given the recommendation of a book that calmed my brain down considerably, Full Catastrophe Living, written for those dealing with the stress and exhaustion of chronic pain and fortuitously updated days before it was suggested to me.

By October when I was heading to India with my mum, I felt like I was hanging on by a thread. I sat in a pile of clothes, packing in tears. I was happy to be taking her to a country she wanted to see, but feeling like I might just stop functioning somewhere between Jaipur and Agra, and fall into a deep, long sleep.

As many of you know, we did have a terrific time in India, exploring the chaos and colour of Rajasthan in a few too-short weeks.  But I did still get sick again and again, and much of the trip is cloudy with pain, too. By the time I flew home to Canada, the airline stewardesses took one look at me as we boarded the plane and then cleared out the back row and insisted I sleep. I was tired and confused and tired of being tired and confused.

And then, I figured it out.

Finally, an Answer

I kept going back to February when it all began. Earlier in the month I was supposed to go to the Mekong, but I woke up feeling so sick and tired that I couldn’t budge. I had a splitting headache and it felt like someone was pressing on my eyeballs; nothing relieved the pain. I thought I had a bad flu and I postponed my visit. My “flu” cleared up a few days later for the most part, though the headache took longer to go away. A few days later, when I was visiting Vung Tau with my friends, I developed a strange rash all over my stomach. It wasn’t itchy — it was just flat red dots that appeared in constellations all over my torso and around my belly button. I remember my friends Christian, Marie-Claude and Andre all staring at my stomach one morning, confused as to what was causing it. We went with heat rash, and quickly forgot it existed. A few days later it was gone.

What could have caused the rash and my flu-like symptoms and then all the tiredness, joint issues and pain?

Dengue.

Interestingly, that’s exactly why Marie-Claude and Andre were in Vietnam — they had gotten dengue in Bangkok and were in recovery on their visa run. I Googled “dengue rash stomach” and saw exactly what was on my stomach in Vung Tau. And then I looked into what happens when you don’t take care of yourself when you have dengue. Those who have experience with it will know that the disease is not really treated per se; treatment involves hospital visits, hydration, and rest, and monitoring white blood cells and platelets, both of which are dangerously low when in the throes of its grasp.

But I learned that when you ignore it as I did, it starts wreaking all sorts of other havoc on your immune system, on your joints and on your general state of being.  I went to a tropical diseases doctor and presented my case, and they confirmed that dengue is almost certainly what had happened, especially given a February infection and my subsequent blood test results, which showed a lower-than-normal white blood cell and platelet count.

According to the CDC, the principal symptoms of dengue are high fever and at least two of the following:
Severe headache
Severe eye pain (behind eyes)
Joint pain
Muscle and/or bone pain
Rash
Mild bleeding manifestation (e.g., nose or gum bleed, petechiae, or easy bruising)
Low white cell count

There’s little to do at this point other than listen to what my body tells me, resting more, staying out late less, keeping the long haul flights to a minimum. (The time zone changes and effects on your body’s adrenal system were, my doctor said, particularly problematic for long hauls.) I’m back in Saigon now and will be taking one big trip this season, but otherwise staying still. And, you know, avoiding mosquitoes to the extent possible. Damn you, mosquitos.

So, after many months of not saying anything I’m writing this post to reiterate what not to do when you get dengue. Or, put another way, when in dengue-prone areas and having symptoms of the flu, if you then see a rash on your person GET THEE TO A DOCTOR. I wish I had gone to check it out, and could have then taken care of myself properly.

Don’t forget Chikungunya and Zika

Dengue, Zika, and Chikunyunya are all carried by the pesky Aedes aegypti mosquito. As is yellow fever. And of all the mosquitoes out there, this one will happily breed in even the most shallow of water sources.

Aedes aegypti is not the only species to carry the disease, but it is likely the most efficient: It happily takes up residence in human dwellings, biting many people in a row. If it feeds on a sick person, the disease incubates in its belly, then migrates to its salivary glands. It is injected at the next bite.

[…]

After six dengue-free decades, Brazil had its first outbreak in 1981. The situation has deteriorated: Last year, 1.6 million people in Brazil were diagnosed with dengue, more than ever before. Chikungunya and Zika have infected hundreds of thousands more.

– Zika Uncontained, Frontline

An American reader living in Manila for many years kindly sent me her story of both dengue and a similar disease called Chikungunya. In her words:

“My experience was horrendous. Very, very similar to what you went through. The reason I am emailing you is to let you know it’s very likely you had both dengue and Chikungunya. The mosquito that carries dengue can also carry Chikungunya. If you get bit by a mosquito carrying both, you can be infected by both dengue and Chikungunya at the same time. This is what happened to me.

While both diseases have similar symptons, the main difference is dengue can be fatal, Chikungunya isn’t. However, and this is huge — Chikungunya gives you terrible joint and muscle pains. These pains can last up to TWO years! Eventually you will recover completely though. And it can also leave you exhausted. This is all somewhat new – in fact most of us had never heard of Chikungunya before. There was an outbreak in Manila, and there has also been an increasing number of people getting both dengue and Chikungunya at the same time. Most ridiculously, there is not enough information about this.”

So, something to keep in mind if you’re exhibiting symptoms of the kind I mentioned. The rash for Chikungunya is generally on the stomach area, per what I’ve read, and joint pains ongoing. The symptoms for both diseases are quite similar, per the CDC, and it has so far been found far outside its usual locations and as far as Texas, Spain (as of August 2015), Mexico, and more, including the Caribbean where it was first detected in the Americas.

Zika Rears its Ugly Head

As if dengue and chikunyunga weren’t enough, zika is now a real threat — one growing in concern due to the terrifying effects on unborn children. This disease is also carried by the same Aedes aegypti mosquito as the other two viruses, a particularly resilient creature who can explode in population in much of the world.

Given that the three illnesses offer up similar symptoms, I wanted to devote a part of this post to Zika as well. The virus didn’t just appear in 2016. In fact, it’s been around for a long time. First identified in monkeys in Africa (Uganda to be exact) in the late 1940s, it spread to humans around the early 1950s. The World Health Organization documents the first case at 1952.

In recent years, with a warming planet and an increase in travel, the disease spread. In 2007, cases were reported in the South Pacific’s Yap Island with a larger outbreak on French Polynesia and in Brazil in 2013.

Zika’s symptoms are reported as quite mild — far more so than my dengue symptoms noted in this piece. Per Vox’s Zika Primer,

Zika produces very mild symptoms — rash, headaches, pain in the bones, and fever — that usually show up between three and 12 days after a mosquito bite. These symptoms usually go away within a week, and one in four people don’t even develop any symptoms after being infected with the virus. This means people don’t usually go to the doctor for Zika, and many cases go unnoticed. There’s also no vaccine or treatment for the virus, so doctors just work on controlling and alleviating its symptoms.

Prior to 2013, the disease was not in the Western media, partly because of these mild symptoms and a fairly low mortality rate (compared to, say, malaria or dengue). However, given its now-establish effects on pregnant women and microcephaly in their fetuses, the disease has become a global concern and opened up debates about women’s rights and contraception in the often-conservative countries that Zika has thus far spread.

Please see the end of this post for more articles about Zika.

An End to My Year

A few days ago when my toe hit my bed frame I heard it crack, a small echo that resonated despite the fact that I was on the curled edges of sleep. Clawing out of morning cobwebs I peered down, noticing quickly that my toe was bent forward at an unnatural angle, the pain radiating into my foot and up my leg.

I didn’t go to a doctor (I know, I know) because everyone and their mother — and even mine too — said that there’s nothing a doctor can do for a broken toe. I examined it, saw that it wasn’t turning grey or losing circulation, and that there was no open fracture or jutted bone. And then I ate a melon popsicle, cut it into pieces and made an awesome DIY splint, resigning myself to another few weeks of limping, of Vietnamese neighbours pointing at my toe and shaking their heads (in sympathy, not disgust) and of doing my food walks a little more slowly than I had initially anticipated.

My friends here were more positive.

“This all makes sense!” one of them exclaimed. “You started the year of the Snake so badly, with your toe and dengue. And now you are ending it by hurting the other foot. The snake is eating its head. You have come full circle!”

I listened to what they were saying, and I looked down at my toe. I thought about this year of pain and exhaustion coupled with great press for the site and other business success, and then of new beginnings.

“You know”, I said, musing about the last twelve months, “I am born in the year of the goat. And it’s common for goats to have trouble in snake years, but we’re about to head into the year of the wooden horse, and goats do much better then.”

And my friend looked at me, and then looked down at my toe and giggled.

“Jodi, either you are a Vietnamese person under all of that Canadian-ness, or you’ve just been here too long.”

I look forward to ending the Year of the Snake too, and ushering in the Year of the Horse with open arms.

-Jodi

Update from 2016 about Dengue, Chikunyunya and Zika

Thus far, 2015 and 2016 have been banner years for mosquito-borne illnesses, with more and more mainstream news coverage about the disease. I currently have friends in Siem Reap, Cuba, Rio de Janeiro, and Delhi who have dengue at the same time and in very disparate places. One of the hardest symptoms following dengue is the depression and anxiety that follows. Given how prevalent it is becoming, as well as the additional reporting about chikunyunya and Zika, I wanted to add a few more resources:

Dengue

• A Sept 2, 2015 piece from CNN about dengue and how it travels.
• From Manila, 55,000 cases so far in 2015 (as of September 4, 2015)
• From Cambodia, dengue on the rise in 2015 – also a lot more cases than last year at the same time.
• Dengue cases up in Singapore in 2015.
• The Western Pacific Region of the WHO has a dengue update often. Here is the most recent dengue situation update, including updates for Southeast Asia, the Pacific Islands, Australia and more.
• Dengue cases up 40 percent in the Philippines in 2016, and dengue reported in “every province in the Kingdom of Thailand” for 2016 also.
• Huge dengue outbreak in Sri Lanka in 2016, with 40 deaths and almost 23,000 cases as of July 1.
• Interesting article from the Smithsonian Magazine, about how the isolation of a single protein could help develop a vaccine for dengue. This is a different vaccine than the Sanofi one that is in development and testing stages, since it targets a protein that, if this piece is correct, could help protect against all of the dengue strains.

Chikungunya

• World Health Organization’s Chikungunya fact sheet.
• NPR in 2015 on how chikungunya might be scarier than we thought. (“”As it spreads across the world, we’re realizing that it’s not so benign” says Dr. Desiree LaBeaud, a professor of pediatrics who studies the chikungunya virus at the Stanford University School of Medicine.”)
• PBS on how a warming planet has contributed to the virus’ spread.
• A history of the virus, and how it spread, from a site specializing in chikungunya.

Zika

• A Vox News primer on Zika (video)
• Why Public Health Concerns for Global Spread of Zika Virus Means That Rio de Janeiro’s 2016 Olympic Games Must Not Proceed
• Proving that the Zika virus causes microcephaly.
• Center for Disease Control information about Zika (USA site)
• BBC on countries affected by Zika and some basic advice.

The frustrating part is, of course, that there is not much to be done other than prevention. There is currently no widespread vaccines (though some are in testing for dengue), and treatment is simply to hydrate, take painkillers (specific ones — do make sure you listen to your doctor as the wrong ones can be dangerous), and wait. The fatigue, the hair loss, the joint pain, and the depression and anxiety are all quite devastating but from my non-scientific poll of many friends who have gotten it, vary from person to person. For me, with an existing immune disorder, it was really difficult. For others, they had a few months of problems but are fine now.

It has been several years and in my case I will say that my circulation has not gotten back to where I want it to be but otherwise I am back to feeling more healthy. I will be returning to Southeast Asia this year, but it definitely worries me that the cases are well on the rise. All one can do is wear mosquito repellant, cover up what you can, and be sure to get tested if you start exhibiting the symptoms of the disease.

Not the most cheerful of updates, but I wanted to make sure I kept the post current!

-Jodi