FAQ: Any weird diseases in your travels?

People are always interested in how we take care of medical problems when we're out of the USA, especially in third world countries and they frequently ask if we've contracted any “weird” diseases on our journey. The answers are … pretty easy and yes. Getting medical care in third world countries is not all that difficult. We've not been in the jungles of Borneo or in remote Antarctica with major illnesses, so we can't comment on those situations. In general, however, we've been able to obtain reasonable medical and dental care wherever we've been. From mammograms in six different countries to an ear infection in the Galapagos, a URI in Ecuador, emergency major surgery in Chile, a sore that wouldn't heal in Vanuatu, and a toothache in Ushuaia, Argentina at the bottom of the world … we've always found adequate care at a fraction of the cost the same treatment would have cost us in the USA.

Quite honestly, none of the medical problems we've experience in foreign countries would fall into the “weird” category. All the weird diseases have occurred in the USA! In Boston one year, I contracted Lyme Disease caused by a tick bite. Lyme Disease was easily recognized … a very noticeable bull's-eye rash on my arm. With the help of the internet, I self-diagnosed, but had to go to a local doc-in-the-box to get verification and an Rx.

According to the CDC (Centers for Disease Control), there are “329,000 new cases [reported] each year in the US. Lyme disease is one of the fastest growing infectious diseases in the US and Western Europe. In September 2015, the CDC revised their estimates indicating ... an increase of up to 10 times what was previously believed.” I guess it wasn't that unusual to have Lyme Disease based on its current prevalence in the US, but it certainly seemed weird at the time.

A few years later in Las Vegas, I woke in the middle of the night and my head was spinning (no alcohol involved). I could barely walk and was so dizzy, I began vomiting. Even laying flat in bed and not moving kept my head spinning. Believe it or not, we found a “dizzy clinic” in Las Vegas (go figure!). I was diagnosed as having BPPV (Benign Paroxsymal Positional Vertigo) … who could have known? BPPV is caused by “calcium carbonate crystals (otoconia) that are normally embedded in gel in the utricle becoming dislodged and migrating into one or more of the three fluid-filled semicircular canals.” i.e. crystals floating around in the inner ear. They used the simple Epley maneuver on me and the symptoms disappeared quickly. Interestingly enough, while on a road trip in California a couple years later, David had the same symptoms. We reviewed the steps of the Epley maneuver on line, followed the procedure and David was fine within hours.

How prevalent is BPPV? Well, according to my internet research, an epidemiological study reports “Eighty percent of people aged 65 years and older have experienced dizziness, and BPPV, the most common vestibular disorder, is the cause of approximately 50% of dizziness in older people.” So I guess, David and I aren't alone, but it certainly was an unusual occurrence for us.

So, what's latest? A month or so ago when we were in Boston, David noticed a rash on his upper legs. It wasn't itchy and didn't really bother him and he thought it would go away. By the time we had been in Vegas for a week, it had worsened and spread further down his legs. We took a trip to Urgent Care where the on-call physician diagnosed “multiple non-venomous insect bites” and assured us that the rash would disappear in a couple of weeks. We disagreed with the diagnosis, but the doc knew best. Predictably, the rash worsened and spread further down his legs to his feet. We returned to Urgent Care where the on-call physician looked at it and said with a straight face “Geez … I have no idea what that is.” Another physician stopped in to take a look. “Wow … that's interesting. See a dermatologist.”

There are no life-threatening dermatological conditions which require an emergency same-day visit, but after many phone calls, we found a Board Certified Dermatologist on the west side of town that could fit David in immediately. He took one look at David's legs, smiled and said “Schamberg's Disease”, also known as progressive pigmentary dermatosis. The doc brought in a textbook with colored plates and showed David the photos that he could have posed for. There's not much known about Schamberg's. It's rare and the cause is unknown, though there's much speculation. It's benign, non-contagious, eventually goes away and there's not much to be done about it. It looks awful, so David has taken to wearing long pants all the time till the rash disappears – so as to not scare little children.

Just chock it up to another weird disease … in the USA.

FAQ - Do you worry about tropical diseases?

In light of the current Zika pandemic scare, we've been asked frequently about whether we worry about catching exotic diseases that are more prevalent in tropical areas and third world countries and the answer is yes and no. Yes, it's a concern, but we take all reasonable precautions. And, no, we don't worry so much that it prevents us from sailing in the tropics or to third world countries. When we were at Pitcairn Island in 2007, the bird flu was the big scare. The Pitcairners held an island meeting (all 46 of them) and decided to “close the island” until it was prudent to allow visitors again. We were already there and had previously been at sea for more than 14 days when we arrived, so they figured we were safe enough. They did, however, have the island health officer give us a once-over.

We were in South Africa and Namibia when the Ebola virus hysteria was at its peak. We were more concerned that we wouldn't be able to fly out of Africa to the USA for the holidays than we were about actually catching the disease. As it turned out, we had our temperatures taken while waiting in the ticket line at the airport terminal. If there was no temperature, we were allowed to board. We had no problems.

And, now, of course, it's the Zika virus that's the concern. The big difference with the Zika virus is that it's transmitted not by birds or other mammals, but by mosquitoes, much like yellow fever, malaria, dengue or the West Nile viruses. One major difference, however, is that the carrier culprit (female Aedes aegypti) is a daytime-active mosquito. In case you didn't know, the Zika virus was first identified back in 1947 in the Zika Forest of Uganda, hence its name.

I found a map which shows the current probability of Zika distribution and occurrence worldwide, and obviously the more tropical areas are the most likely.

As of this month, there have been 16 confirmed cases of the Zika virus in Trinidad. The Minister of Health, Terrence Deyalsingh, has cautioned the population not to panic. Regarding concerns that Zika could be a life threatening public health issue, he said “what you do not want from Zika is panic. Please keep it in perspective. Please let us keep our heads on to eliminate this”. He said that the virus needs to be attacked on the ground level, with a public education and clean up campaign. He said “if you have 100 people in a room, eighty per cent will not show symptoms”. Deyalsingh said: “I am appeal to everyone. Do not create unnecessary panic. The comment of Zika take you, you going to die, is absolutely not true”.

I wasn't sure I'd trust the Trinidadian Minister of Health's comments, but the CDC had the same type of information. “People usually don’t get sick enough to go to the hospital, and they very rarely die of Zika. For this reason, many people might not realize they have been infected.” Obviously though, the concern of pregnant women for birth defects in unborn children and the possible tie of Zika with Guillain-Barré Syndrome is very real.

So what precautions do we take in general? We have had yellow fever shots in the past and had a booster before we left South Africa for the Guianas. The most prudent precaution, other than not visiting the areas at all, is to cover up and use insect repellent religiously, which we try to do. In the past, we were especially careful about the dawn and dusk hours when mosquitoes are most active, but with the Zika, it's an issue all day long. Fortunately, mosquitoes are less of a problem along the coast and we've not been bothered by them. We did get bites while touring the Caroni Swamp despite the insect repellent we applied. So far, no problems. Considering there are only 16 identified cases in Trinidad, we think the chances of contracting Zika are pretty remote.

That said, we're thinking of stopping in Puerto Rico on our way north which already has 475 reported cases of Zika, most acquired locally, i.e. bitten by an infected mosquito versus travel-related or sexually transmitted. We'll take extra precautions when we stop there, e.g. mosquito netting, care with insect repellent, covering up during the day, etc. Being aware and prepared is part of the battle.

FAQ - Do you have boat insurance?

Well, it's boat insurance renewal time again … a depressing, expensive time of year and one which really impacts the budget. Comparative to house insurance or car insurance, boat insurance is over the top … thousands instead of hundreds of dollars. David's written about having boat insurance in the past and I thought I'd reiterate … mostly because misery loves company.

If you have a mortgage on your boat, just like a house, you must have insurance. We never had a mortgage on Nine of Cups, but the investment was substantial enough (like a house without a mortgage), that we felt insuring her was important. After a couple of years in the Carib, when it was time to renew, the insurance company told us we could not go to Colombia. We took exception to their exception and canceled the insurance and muddled around until 2009 uninsured and without consequence.

When we arrived in New Zealand, we were required to have insurance to check into any marina, be on one of their moorings or be hauled out in the boatyard. Only third party liability was required and it was relatively inexpensive ($300-400). We bought it, so we could haul out. We sailed to New Zealand's South Island that year and while we were in Picton, cruising friends who were on a land holiday, stopped by to say hello. We talked about boat insurance at length. They were insured, but it was such a huge chunk of their budget, they wondered if it was worthwhile and they were thinking about not renewing. Fast forward one month later … they hit a reef near Whangaroa and their boat went down in a matter of minutes. The insurance paid up and they bought another boat. When news of our friends' loss reached us, it gave us food for thought and lots to ponder.

We investigated several insurance companies and finally found one through a local New Zealand agent that was underwritten by Lloyds of London and that we think provides us with the best coverage without breaking the bank. We now renew our insurance annually as painful as it might be. Have we ever had a claim? No … and really that would be the ultimate test of how good the insurance policy really is.

I will tell you that reading the fine print of our policy is a lesson in patience and, at times, incredulity. For instance, we are NOT covered for cyber attacks, civil war, insurrection or rebellion (or mutiny of the crew). We are not covered for radioactive contamination nor chemical, bio-chemical, biological nor electromagnetic weapon attacks including the explosion and subsequent consequences of a nuclear reactor. Oh, the list of exclusions is very, very long, but of course, we're hoping we never have to worry about them.

One thing to consider with the cost of the insurance is that some agents charge credit card fees; there are fees for foreign-currency exchange if that applies and if not, fees from your bank for a wire transfer.

We know many, many cruisers who do not opt to insure and just as many who do. It really depends on your peace of mind, what risks you're willing to tolerate and how much you have invested in your boat. Again, some marinas (especially New Zealand and Australia) require proof of insurance. Australia, by the way, requires AUD$10 million liability insurance, but our $5 mil policy from New Zealand sufficed when we discussed it with them and they made an exception.

Our liability insurance was reduced to US$1 million this year because we're returning to the USA … not sure why, but it did. Americans are a litigious lot, perhaps that's the reason. We are required to be either south of 12.07N (e.g. Trinidad) or north of Cape Hatteras between 1 June and 30 November or losses from a named or numbered windstorm (i.e. hurricanes or tropical depressions) are excluded. We're also not insured if we opt to go to Venezuela, Haiti or Cuba.

We'll be lucky if we get all of our work done on Cups and get out of the marina by June, so this time we're okay with the restrictions. Now if we can just keep the crew from mutinying ...