Recommended Reading

Turn Right at Machu Picchu: Rediscovering the Lost City One Step at a Time
by Mark Adams

The "No" Post

I read a book to my son called No David. Each page of the book features a kid (David) having a wildly good time. He plays pirate in the bath and creates wild waves that crash over the sides of the tub. He swings a baseball bat and hits a home run inside mom's expansive living room. He runs naked through the streets of his quiet, tree-lined neighborhood. All the while, on each page, his mom scolds, "No, David!"

Poor little David. Where's all the fun?

That's what this post is: The "No" Post-- Peru Edition. Courtesy of Penn Travel Medicine and seasoned South American travelers everywhere. (The "Why?" posts are the Healthcare Prep posts, seen below.)

In Peru, no:

Local Water. Unless bottled, sealed--and check the seal!

This includes: No ice in your drink. No frozen drinks. Starbucks Frappucinos in Lima would be made with local water.

Carbonated drinks (not bottled, the kind you might get at a bar or restaurant) contain local water.

Mixed drinks from a bar: contain local water. Beer from a tap? Sorry. No.

Anything you drink should come from a sealed bottle. The end.

Brushing teeth? Use bottled water. 

Drinking coffee? Well, boiled water is okay-- but don't use that cream unless it came from a sealed container. 

Was it sealed? If you didn't see it, don't trust it. 

Like ice cream, from a street vendor. No. (Did you buy the ice cream and remove the lid yourself? Well, okay then.) 

No uncooked vegetables of any kind. No salad. At Subway in Lima? No lettuce. No tomato. (Why are you at Subway and Starbucks anyway, for goodness sakes? You're in Peru!)

Fruits? No: Except those with thick skins. Oranges, limes, pineapple.

Any questions? Then NO, don’t eat it!

Breads, grains, cooked meats, and seafoods should be okay.

Enjoy. (Whimper.)

I'm Overwhelmed!

We are about 40 days out from our trip.

Let's simplify your Peru Prep:

• Have you made an appointment to see a travel medicine specialist AND your family doctor? (Your regular doctor won't have the yellow fever vaccination.) Call Penn Travel Medicine: (215) 615-2584.
• Do you have your passport?
• Have you ordered any supplies you can't get at a basic store (like CVS or Walgreens)? See my post on "Shopping: Peru Prep".
• Have you checked in with your travel coordinator (Dr. Moelter) for updates on payments, flight schedules, etc?

Coming soon: What to pack.

Shopping! Peru Prep

Should you? Could you?

[Camo Coll Mosquito Net/Hat, $12.99, available on amazon.com. Eyelashes optional.]

You can grab most of your Peru essentials at CVS or Walgreens, particularly travel sizes.

• All of your basic toiletries: Shampoo, soap, razor, etc.
• All of your Peru OTC needs: Imodium, Tylenol (or your preferred headache medicine), Benadryl, hand sanitizer, sunscreen, travel-sized clothing detergent.

Some things, however--and these are ESSENTIAL--can't be found at basic drugstores. You can find these at a specialty sporting/camping store (REI, Dick's Sporting, etc.) or order on Amazon.com:

• Insect repellent that is a minimum of 35-40% DEET (for skin application)
• Permethrin (insect repellent for clothing)

I always have questions about chemicals like DEET, and I offer you the CDC fact sheet on it:
http://www.cdc.gov/malaria/toolkit/DEET.pdf

Here's the key for DEET: The higher concentration (50% DEET vs 7% DEET) is not more effective. It is longer-lasting. Do you want to spray once in the morning? Or do you want to spray every 20 minutes (and miss all the fun)? The Penn Travel Medicine specialist insisted I purchase a minimum of 35-40% DEET.

Curious about the "natural" insect repellents (eucalyptus sprays) or gadgets (bracelets or belts that repel insects)? Me too. But honestly: try them stateside if you want to experiment, not in yellow fever terrain.

Havana (Cusco?) Omelet: Traveler's Diarrhea (Healthcare Prep, Part III)

Havana omelet. Hershey squirts. Montezuma's revenge. Call it what you like; it ain't pretty. It's...  

TRAVELER’S DIARRHEA

What to expect: The doc said it quite succinctly to me: Traveler’s Diarrhea—is any diarrhea when you (she meant me, a suburban girl) travel in South America.

What to try: Cipro [Ciprofloxacin Rx—get in advance from doc]. Take at the first sign of diarrhea along with Imodium (OTC). 

My pal Leah, who frequents remote places for her research, explained this to me: Cipro will kill the bug, but won't stop the flow. Imodium, meanwhile, will slow the ass quake enough for you to comfortably continue with the trip. Without the Imodium, you'll be stuck in a bathroom, even with Cipro. What's ideal, says Leah, is to not take anything and let the bug work through your system, uncomfortable as that may be. But--huge caveat--that's if you're doing research in India for 6 months, and you have the time to lose. This isn't our trip.

Of course: Rehydrate. Seasoned travelers bring individual powdered Gatorade packets to put in bottled water. Carry an emergency high-protein bar, in case you have a day where you don’t feel much like eating. Read my related blog post [The 'NO' Post"] on eating in Peru, and I hope we can avoid all this. 

When to worry: Once you have taken Cipro for three days (you shouldn't have to), you need to see a doctor. 

“Soroche”-- Altitude Sickness in Peru (Healthcare Prep, Part II)

I live in New Jersey, at sea level. Altitude 0.

The altitude in Philadelphia? 39 feet.

Lima, Peru? 5,080 feet

Cuzco? 11,152 feet.  Ollytaytambo? 9,160. Machu Picchu? 7,972. And Puerto Maldonado? Back to 600 feet.

Above 8,000 feet, where the air is thinner, you might experience altitude sickness. How the altitude will affect you is completely unpredictable. You might be a marathon runner and be incapacitated by headaches--or it might only affect you only slightly. Here's a brief primer on what to expect, and how to prepare. (If you already know, as I do, that altitude affects you severely, talk to your doctor about the Rx for Diamox.)

ALTITUDE SICKNESS

What to expect: Headaches, sleep disruption, labored breathing while exercising.

What to try: Tylenol, Excedrin, or whatever you normally take for headaches. Adjust expectations for how much, physically, you will be comfortable to do.

Preventative:  Hydration is imperative! Caffeine, sodium, alcohol, and the flight will all dehydrate you, as will the elevated altitude once we leave Lima.   

• 8 x 8 oz glasses (bottles) of water each day (at least) ahead of and during trip. (In Peru, we'll drink bottled water.)
• Diamox [optional Rx] for altitude illness—talk to doc ahead of time.
• Travelers, NOT DOCTORS, will recommend Cocoa Tea or leaves. (See my related post [The "NO" Post] about avoiding fruits or vegetables. DON'T eat the leaves, guys.) Cocoa tea is not available (i.e. not legal) in the U.S. You'll find it in Peru readily. It contains cocaine (cocoa plant). You should avoid drinking this tea if you will be drug tested for any reason. You'll test positive for cocaine. (Pharmacy students--are you ever randomly tested?)

When to worry: Severe headaches; or if respiratory congestion or labored breathing continues once exercise has ceased. Blurry vision, passing out (means brain swelling)-- must be medevaced out and taken to lower altitude immediately.

Oh, Gnats! Peru Vaccination & Healthcare Prep (Part I: Mosquitoes)

I spent the morning with the terrific travel medicine specialist at Penn Travel Medicine Center at University of Pennsylvania. Be forewarned: they don't take insurance. The consultation ($95) was about an hour, and worth every minute. What an education! I'll do a couple of posts on what I learned-- though, I must confess, I paid closest attention to what applied to me. Individual circumstances and choices will vary widely. (Go see your own doctor, this isn't medical advice, you know the drill.)

First, go prepared: Fill out the forms they provide in advance. Bring your vaccination record and your itinerary: Your altitude (locations visited, duration of time spent in each) will determine a lot of your treatment plan.

I'll start with the mosquitoes. (See my other posts [Healthcare prep Posts II and III] for Altitude Sickness and Montezuma's Revenge.)

MOSQUITO-BORNE ILLNESS

What to expect: Mosquitoes thrive under 2,000 feet. We'll be in Puerto Maldonado, in the Amazon basin, for two or three days, at sea level. 

NIGHTTIME MOSQUITOES (i.e. "aggressive at night") transmit Yellow Fever [Vaccination recommended, $175] and Malaria [Rx recommended]. The Malaria treatment [Rx] varies by cost and elements of treatment. Speak to your doctor. I'll be taking Malarone (something like $7 a pill and considered expensive, 96% effective). You take it two days ahead of travel, and continue through seven days after completing travel. Check to see if your lodge has mosquito nets, screens in the windows. Our does. I think. 

DAYTIME MOSQUITOES (i.e. "aggressive during daytime") transmit Dengue Fever, Chikungunya, and Zika. There's no vaccination or Rx for these; you simply attempt to prevent with insect spray and smart clothing. (Crossed fingers.)

What to try: Preventative measures are essential.

• Clothing is your first line of defense: long sleeves, long pants, long socks UNDER pants. See that photo above? Hear me when I say LONG PANTS.
• Insect Repellent: Get 20-35% Deet, Long-Acting (10-12 hours)—One container will be fine for our three days. Spray directly on skin. (If you get anything not long-acting, or at a lower %, you will be spraying constantly.) In addition: get Permethrin—Insect repellant that ONLY goes on clothing, never ON SKIN. 
• Mosquito netting (sleeping): Great tip: Bring a couple of rubber bands in case nets get holes.

What to try: For swelling or a severe histamine reaction, they recommend Benadryl or OTC cream.

When to worry:  If you have flu-like symptoms (fever, cough, or joint pain), you must follow up with your doctor.

A note: Zika is in the news nearly every day here. I must confess that I carelessly waved away the Zika talk. Childbearing-age women: beware and pay attention. 

I won't describe here what happens if you contract one of these illnesses-- and at this time, that's not a huge concern (focus?) of mine. Here, in New Jersey, we fuss and take a good number of precautions for any basic Pine Barrens hike or camping trip--not with mosquitoes, but with ticks. So, I'm pretty used to adapting.

Next time: Traveler's Diarrhea and Altitude Sickness.

PERU PREP

Heading to Peru in May-- and have decided to resuscitate this blog in an effort to keep track of all the preparations swirling around in my head. There are vaccinations, prescriptions and OTC items to prep and pack; clothing to coordinate for all kinds of climates: urban Lima, the rainforest Amazon region, and high-altitude Machu Picchu. There are safety and food warnings to heed, and even more research to enjoy. Here goes.