I once moved into a house in Tampa vacated by a family with a dog. Pretty soon I was checking into hotels, flea bombing the place, and trying to work with big water boils on my legs. After professional help to kill the fleas, a friend told me I should have borrowed a dog to run through my house and then just bathe it in flea shampoo afterwards. A few years later, around 2010, I had another episode, but this time the bites were on my behind. I had swum in Guyana in a recently dug creek turned stagnant lake as well as in the sea at a beach that was not terribly clean — dead dogs and all. I even suggested that the hotel where I was staying had bed bugs. After multiple doctor visits and steroids, I was referred to a dermatologist. I was allergic to certain bites and I got some prescription cream. This was my fate.
In 2015 I added sand flies to the list as my body reacted to their bites after spending a week at a certain caye in Belize. If I looked back in my phone I’d find photos of what these look like each time I go to Belize. Welts and water boils. Sorey minnah is what one would call me if I were a kid in Guyana. In retrospect, throughout my childhood I had small water boils on my hand. Thought it was either from catching guppies in the dirty trench outside the yard, or from bracing my hand against the net at night for the mosquitoes to feast. Now, I get these on my feet from fleas or sandflies and they get much bigger than those from childhood. I’ve learned that Guyanese crab oil helps reduce the number of bites I get in Belize though I think the mosquitoes and sandflies there have built up a tolerance to the bitterness over the years.
When what appeared to be a bite like the rest showed up close to my ankle last week Tuesday or Wednesday, I thought it was just that. A bite from something to which I was allergic. It was swollen with two tiny pockets of fluid. When I went to bed on Thursday night it was hurting. Thanks to a loud snorer next door, I woke up really early and ended up surfing the net. I learned that Pennsylvania was #1 in the nation for lyme disease and wondered if a tick had bitten me. On Friday morning during a meeting, I looked down at my ankle. A water boil the size of my big toe glared at me.
Tonight, my colleague Christian Wells shared the poster of a movie he was about to see. While the boil on my foot looked more watery than the one on the poster, I thought I could fill in a scary story. Once I landed in Tampa I went to urgent care. The doctor looked at it, now full again despite bursting a few times. She said I had a staph infection in the making. I showed her pics from earlier on Friday as it looked different and I wanted to know if the bursting caused the infection. She said, it was already getting there that morning. Her write up names it cellulitis. I whipped out my phone when she left the room and the first thing I read was, “What Almost Losing My Leg Taught Me About Grit and Grace.” I had googled “staph infection ankle.”
I was given a doxycycline pill and prescription for 14 days. By the time I left Urgent Care, I had read up about the multiple antibiotics used to treat staph infections depending on the particular strain of bacteria and the challenges with many that were now resistant to antibiotics. I had also read about endocarditis. I had just recently chatted with a colleague about my heart attack in 2017. Her husband had had heart surgery to replace heart valves. He had endocarditis that had presented as a flu, as being listless, and as having aches and pains. Here I was now reading that staphylococcus bacteria, the bacteria responsible for staph infections, could infect the heart and cause endocarditis. When you have stents in your body, like any artificial thing you might have implanted, the dread of it being a host to bacteria is real.
As an environmental engineer, Antimicrobial Resistance (AMR) is a big thing. It was Friday night and I would not see my doctor until Monday. I wondered to whose lab I could send a swab of the fluids from my boil. I began to wonder whether doxycycline was the right drug. I began to reason that I was recently in Guyana where I know doxycycline is used widely for malaria and was distributed to persons across the coast when it flooded in 2005 to combat leptospirosis. If it’s one drug the bacteria were resistant to there, it would be this one. The staphylococcus bacteria infecting my foot could have been in my body for some time. So, imagine the rabbit hole I go. I wondered whether I should have been more cautious swimming after a storm in places that were under construction. Rule of thumb is don’t swim in the sea after a storm, especially if close to human development. I did gulp down some seawater just two weeks ago and there is no water quality data for where I am swimming. Or whether I should have been drinking tap water at one of the places I was staying recently given that my chlorine test strips showed there was no disinfectant present. My aunt opined that maybe I got it when I had surgery for the stents.
The Centers for Disease Control and Prevention actually has an AMR challenge for the world. Haiti is the only Caribbean nation I see listed as a participant to date. When the Association of Environmental Engineering and Science Professors had Prof. Pedro Alvarez as its 2018 Distinguished Lecturer, he presented on superbugs at the University of Central Florida. We discussed the easy access to antibiotics in certain parts of the world and how frightening this looks in the future. Some of this came out in the interview we did with him after the lecture (see from 5:07 in video link below). As someone who likes the sea and snorkeling over coral reefs, I see a clear connection between the quality of water getting into the marine environment and my health. Given that some staphylococcus bacteria survive saltwater environments, swimming after the sun has blazed for some time does not apply. We are ways away from having my underwater camera being able to indicate water safety the way it can indicate geospatial positioning, but one can see from Lawrence Livermore Labs how technology is changing with at least the cost and number of tests that can be done simultaneously. Prof. Alvarez says that environmental engineers can do alot in how they design wastewater treatment plants. I concur and hope that the places where I like to swim ensure they have the best wastewater treatment possible, especially since more and more of us are tanked up on antibiotics. This, however, is a touchy subject for many tourist destinations.
Given that this infection presented itself at an American hotel on a hilly golf course, maybe the take away is that I should stick to snorkeling. And I should walk with my crab oil everywhere. It’s actually andiroba oil if you look for it online, but according to my dad I should use everyday all over my body. Right now I am hoping it has healing powers and can reduce this eyesore on my ankle. It is literally as wide as my socket.