Post exposure rabies treatment

In my last post, you left me bitten by a dog.

It had all kicked off when I was walking towards my hotel in Chum Phae around 6pm on Sat the 13th of Feb. I was minding my own business, wondering if it was too early for a beer when I heard loud barking and felt teeth going into my calf. When I turned round I saw a mangy dog running away and load of locals with a "Oh my Buddha" look on their faces.

My hotel was round the corner so I went in and washed the wound ASAP, first with soap and water then I used an alcohol based wipe. Talking of alcohol I downed a can of beer whilst I was doing this (I had decided it was definitely beer o'clock now).

Next stop was the hospital, which proved to be a mere couple of hundred metres away. I was there being seen within less than an hour of being bitten. The English of the people on the Saturday night shift was better than my Thai although not by that all that much.

On questioning I told them I'd been vaccinated in 2009 but didn't think I'd had a booster. OK they said, we'll clean the wound with ipodine (an iodine based solution), give you a tetanus booster and a rabies shot. Fantastic. Within two hours I was out of there inoculated and with a bag of antibiotics to ward off any of that nastiness.  Job, as they say, is a good 'un.

Now, let me regale you with some interesting info on rabies. It's a virus and it's fatal within 2 to 10 days once it crosses the "blood brain barrier" (that is enters the central nervous system). Treatment at that point is industrial grade sedatives and pain killers until you die of respiratory failure (OK, turns out this isn't entirely true: the Milwaukee treatment has been tried on 42 people since 2005, and 6 of them have lived albeit with varying degrees of severe neurological damage: the treatment consists of inducing a coma for a couple of months and hoping the disease runs it's course).

So, you need to catch the virus before it crosses that barrier and enters the CNS, which is where the vaccine comes in. Vaccines, as I'm sure we all know, work by stimulating the body to produce the antibodies it needs to fight a bacteria or virus by using a noninfectious variety of the genetic material (in this case of rabies). By having a prevaccination my body had some antibodies and a memory, a template to work from, that would be stimulated further by the vaccine pumped into me, so my body would be rocking well before the pesky rabies proper kicked off in my system! Hurrah!

I woke up at four the next morning in a cold sweat. I hadn't had any booster, I could've have sworn. If so this meant my prevaccination was as good as useless. I checked the internet and I was right, if I wasn't prevaccinated I needed human rabies immunoglobulin (HRIG) as soon as possible and definitely within 24 hours of being bitten... This is a solution of the antibodies the human body produces to fight the rabies virus. It's needed to fight the infection whilst the body ramps up to produce it's own antibodies. The World Health Organisation page is probably the best reading here.

So. It was 4AM on Sunday morning. If I hadn't had a booster four years ago I needed immunoglobulin. If I had, it was all fine. But I couldn't find out for sure until Monday afternoon my time, which was way too late. As I lay waiting for dawn and the hospital to open I looked into the likelihood that the dog had rabies. As a stray I had to assume it did but what were the actual odds? Well, in Asia India has the most cases of rabies in humans followed by Vietnam and then Thailand, with the prime vector being stray dogs. I read some estimates that indicate 1 in 10 strays in Bangkok have rabies. I read other estimates that in the country 15% have it. Then there was the actual nature of the attack: complete random with no "cause"... just what you need going through your head in the hours before dawn.

I was back at the hospital for 7AM. Unfortunately there was no English speaking doctor in until 8 and despite the best efforts of Google Translate and myself nothing was going to happen until then.

Cometh the hour, cometh the doctor. A little after eight I was back and talking to the doctor about getting the immunoglobulin. And the word was no. I had had a vaccination previously therefore all I needed were two shots and that was all. I pointed out it was no longer active to no avail. I said it can't do any harm, she said no. We argued back and forth: search results were shown on the phone. Finally she made a call to a more senior doctor and the word was yes. So at a little after 9AM I was having a skin reaction test and at 9.25 I was finally being injected with immunoglobulin, half into the wound and half intramuscularly (in the buttocks).  

If, if, that dog had rabies I may have just saved my life. If it hadn't? I'd just spent £60 for no reason. 1 in 10 chance that I die painfully in the next month against £60? What would you do?

I was shattered after this. Checked into a very nice hotel and spent the rest of the day sleeping and relaxing at the pool.

That was the HRIG and the "day 0" vaccine shot. That left days 3, 7, 14 and 28 for a total of 5 shots of vaccine. But that's quite enough for one post as it is.

Khon Kaen to Chum Phae

Sat 13/02/14, 100km

Quick shunt 80 along Highway 12 with earphones in to Chum Phase in order to see the remains of an ancient town in the form of some digs dating back some 2500 to 3000 years. I did make one stop at a vineyard in the hope of sampling Thai wine however, they didn't have any wine just grapes and juice. Hello, why?

Arrived in Chum Phae for lunch time,  grabbed a very nice veg red Thai curry at my hotel (Cheewin Palace) and then set off on the bikes for the digs. These had the potential to be really interesting as they seem to have out the bones and potshards back in situ under covered areas. Alas, all the info was in Thai leaving me guessing. Shame.

Chilled for the afternoon then come early evening had a stroll around town, nice place really. Found the local farang bar (I swear these are the Thai equivalent of Chinese or Indian restaurants in the UK, every small town has one!), forbore from a beer as it wasn't quite six then started heading back.

It was at this point that a dog came up behind me and bit my calve. No warning, didn't even see the thing, just felt the teeth go in. This is less than good. Skin broken, blood. My last rabies jab was 2009 and even with a pre-vaccination I needed immediate treatment. So... back to the hotel, wash wound with soap and water, then apply an alcohol based wipe. Meanwhile have a beer and swear copiously. Next stop, hospital. Damn sight better than a British hospital on a Saturday night I'll say that for nowt. Slight communications problems, particularly over my vaccination history however within the hour I had the bite recleaned with iodine and a shot of rabies vaccine... oh and a tetanus jab.

To be continued. And then some.

Very nom red curry

Thai countryside

Some of the digs

Ban Phai to Khon Kaen and a rest day

13/14 Feb 2014, 67km

A quick scoot up the road to Khon Kaen in the morning and then a day and a half of resting to get rid of the building deep muscle ache. The first afternoon I spent at the museum, round the local lake, pizza that sort of thing.

The next I booked into a posh place to use it's pool and also watch some English language TV and films. After lounging by the pool it was off to the local 7-11 for a couple of cans of beer to drink whilst gorging on western media. Unfortunately it transpired that it was a Buddhist festival and alcohol sales were forbidden. Luckily the bar attached to the hotel was happy to sell me a few massively overpriced beers in cinema style paper cups.

The downside of this was I didn't watch any TV, falling asleep by 9.15 instead.

Hah, you all think that's beer! 

Buriram to Ban Phai

Weds 12/02/14, 156km

Weather was quite overcast for much of the day, it felt like I was cycling in Europe. Slight cock up with following Google maps added 20km on to the day but hey ho, easy miles. And that, really was it!

Lots of these trees in bloom at the moment

Hmmm

Nang Rong to Buriram via a couple of Khmer temples

Tues 11/02/14, 96km

Nice though the hotel was the breakfast consisted of cereals (plus coffee, juice, etc). First time I've had cereal for breakfast in donkies years. And there's a reason for that.

First order of the day was Prasat Phanom  Rung. About a 20km cycle, with the last bit up rather a steep slop. Logical considering the ruins are built on an old volcano. And very good quality Khmer ruins they are too! Built around the same time as many of the temples in Angkor they've been restored to a high quality with many of the important features labeled. Part of me would love to see the Cambodian temples given the same love and care although another side likes their wildness.

After an hour of templing it eight kilometres to my next stop Prasat Muang Tam, another lovingly restored temple. Took my time again as there was only a Buddhist monk, his friend and myself there.

Post ruins it was a tootle up to Buriram, home of the legendary Burinam United team at their Thunder Castle ground! Apparently.

Phanom Rung

Selfie time!

Muang Tam

W00t, it's the fricking Thunder Castle!!!

Prasat to Nang Rong

Mon 10/02/14, 118km

On the road by 6.45, expecting another scorcher today as temperature of 36c was forecast. The plan was to start heading northwards towards Chiang Mai and the day started well. By 8am I was approaching Surin and stopped for a quick iced coffee.

By 9AM I was just leaving the coffee place with a change of direction and plan...I'd spent the hour looking at my guidebook and various maps. I think the trigger was the road I was on and the previous days heat. The road was good quality, four lanes plus shoulders, ideal for zoning out and cycling. But also a bit boring and busy. The prospect of weeks of this in 35c heat didn't appeal.

In order to give myself thinking space I decided to change direction towards Prasat Phonom Rung, Thailand's top Khmer ruins. I set my course using Google Maps walking directions and away I flew through the Thai countryside! And then had to retrace my steps when the road disappeared. Eventually I had to back track 28km down the road I'd taken a dislike to. By lunchtime it was hot, hotter than the previous day and I was suffering, particularly when field burning was going on next to the road.

Finally made it to a nice little "boutique resort", the Rainbow Hill Hotel, although there were neither hills nor rainbows in site. Fantastic value at 500 baht. Spent the rest of the day cogitating.

Nice and cool early morning start

Yep, it was an ox cart display... Very much like a car show room

Less than fun to cycle through

An Long Veng to Prasat, Thailand

Sun 09/02/14, 130 km

Omelette for breakfast whilst I watched a very misty start to the day... managed to delay myself until 7.30 which was a tad silly as the forecast high for the day was 34c.

When I did get going and headed out to the border I couldn't but help notice the number of people with missing limbs, usually legs. These will be landmine victims: the border area is part of the K5 zone, which is a 700km long 500m wide mine belt, mined to a density of 6000 mines to the square kilometres.

The cycle to the border took me 12km to the edge of the Dangrek mountains then a steep climb up the mountains. The border area itself was the usual chaos with a casino and traders. Oh, and a sign pointing to the site of Pol Pot's cremation in 1998 - they should've done it to him years before.

Border formalities were simple and brief, with no "Sunday working" or stamping fees. In fact, looked like the most scam free Cambodian border going, probably helped by the lack of public transport o the Thai side which makes this very unused by farang (foreigners).

The road was fantastic quality after Cambodia, with one or two nice views from the mountains. Within 20km I managed to pick up a SIM and 1gb data package.

As the day wore on it got hot... but the air was clearer than Cambodia, perhaps because the mountains contain the smog from the burn off. Made it to an English run guest house on the road Ryan's Resort. Owner is very helpful and the areas British expats were all there for their Sunday lunch. Alas, a lack of veggie options saw my on the bike again cycling 8km to the nearest Tesco Lotus for stuff for dinner

Tapioca root drying by the road, Dangrek mountains in the distance

Statues from Pol Pot's time. Notice that the Khmer Rogue statues have since had their heads removed...

Pol Pot's resting place gets second billing to a cheap flop house

Sra Am back to An Long Veng

Sat 08/02/14, 79km

As the journey and destination were know this was a low stress cycle, with no need to set any sort of speed record: I wasn't templing today after all.

The day started off very hazy and misty but that burnt off soon enough. Unfortunately I was scandalously under provisioned with water, only carrying 1.5l so had to stop for a coconut en route.

Decided to check out a different place to stay and eat just for variety, the New Lucky. If you're in town don't bother, over priced particularly the restaurant.

Spent the afternoon chilling and checking out Ta Mok's house. Ta Mok was "Brother Number Four" of the Khmer Rogue and head of it's military. The house sits by a lake he had constructed, which had dead trees jutting out of it. Kind of says it all. The house? Interesting but don't go out of your way for it.

Field being burnt

Interior of Ta Muk's house

Pol Pots radio car

Ta Mok's lake early the (next morning)

An Long Veng to Sra Am

Fri 07/02/14, 80km

Off to visit Prasat Preah Vihar today. First, breakfast of stir fried veg and rice (coincidentally the same meal I had for dinner last night).

Pro tip here: stopped at the bank in town with a hundred dollar bill and asked them to break it for me. Took ten minutes as three of them inspected it in turn, the last using a jewellers loupe but I got nice small bills in return. And yes, of course I inspected the first they gave me, just until the counter lady laughed.

Fairly straightforward cycle eastwards across one of the less touristed parts of the country. Flat terrain, friendly people. As I didn't stop I made Sra Em for 11:45 and checked into the Reaksmey Sokon Guesthouse ($11 for a large clean fan room, rubbish wifi). Apparently the Sokhon (next door) is a popular tourist choice but as they had ongoing building work I demurred.

Immediately grabbed a quick lunch and jumped into a tuk tuk to take me to the ticket office for Prasat Preah Vihar. Passed lots of army bases and burning fields on the 22km trip (these weren't related BTW).  The temple sits on a mountain top 550m above the plains which is viewable from a way aways (more when fields aren't bring burnt off).

Entrance is free although you need your passport as it's details are taken. The site lies on the border (on) and Thailand has kicked off three shooting wars since it granted UNESCO status in 2008, hence the passport details. Well that and if you stray there are mines in the area (seriously). Costs $5 to get a motorbike up and you need it: slope hits 1:4 at one point.

The temple complex is interesting, pre-Angkorian. Got a prototype bas relief of "the churning of the sea of milk" in it. And some fabulous views even if the air wzx hazy due to the field burning: added a 1970s film stock quality to the place I felt.

Templing done it was back to the guesthouse and time for food, a couple or four beers and bed. Zzzz.

Breakfast of champions. And the dinner as well.

Hill with the temple

Siem Reap to An Long Veng

Tues 06/02/14, 136km

After a large buffet breakfast at the hotel it was time to get on the road again (we know a song about that). Negotiated my way down the traffic nightmare that is highway six and after a slight navigational error (road is signposted Angkor Wat about 8km from town) I hit highway 67 which was going to take me the rest of the way. This does go through the Angkor park however I was assured I wouldn't need a ticket.

For the first twenty or thirty kilometres there was a lot of tourist traffic heading out to Bantreay Srei but once I'd passed it, it was like I was in a different world. At first it was rice paddies and palm trees and then the terrain got a bit wilder. Eventually there was a belt of jungle to be passed. Lot of ash in the air at the end due to fields and scrub being burnt off.

Did the day in one sitting despite a plan of stopping around the 80km mark. And no ankle problems!

An Long Veng is a small place but has a few guest houses that seem OK. I checked into the Monorom ($8 for a fan room) and grabbed a late lunch followed by a shower. Not many tourists here, just three who'd come down from Thailand and a group on dirt bikes. Positively barren after Siem Reap!

Passed a fair few trees like this, not sure what the cloth means... Something Buddhist?

DEET shower tonight I think

So this is where you find the Cambodian rules of the road. Stapled to a tree.

Siem Reap

03/02/14 to 06/02/14

We did the trip from Kampot to Siem Reap on the luxury Giant Ibis bus, a snip at $25. And it is luxury compared to other buses.

We were picked up early and the bus left on time for Phnom Penh where it was a change for the Siem Reap bus. Lots of leg room, no stopping to pick up every Tom Dick or Harry and English language films. Just as well as the journey took seven hours.

On arrival it was time for Sheila to do a tad of souvenir shopping and then a few glasses of wine. Oh and finish the gin off. Spent the next day somewhat hungover around the pool with Sheila topping up her tan and me just wanting to die. Had a last lunch then it was tuk tuk to the airport and farewell...

On the way back I found a dentist. Front part of my bridge had started crumbling a few days ago and emergency repairs were called for. This set the tone for the next day as well: laundry, shopping for new clothes (my original shorts are almost completely worn out to the point of embarrassment), getting bike fitted with new parts and serviced and so on.

Kampot

29/01/14 to 03/02/14

Hadn't planned on staying so long in Kampot, in fact we'd booked bus tickets on to Sihanoukville for the day after we'd arrived. The Chinese new year put paid to that though, as when I checked hotel availability there was nothing really below $40 a night and precious little of that.

This led to a longer stay in Kampot, a relaxed little riverside town not too far from the coast famed for it's pepper (it's actually got Geographical Indicator status in the way that Stilton, say, has).

Spent a couple of days lolling and did some excursions ranging from a sunset river cruise to see fireflies (very good) a "grand tour" of the area (salt pans, caves, pepper plantation, Kep beach [rammed with Khmer's celebrating the new year], going round the deserted French buildings in Kep, lots of tuk tuking through the countryside and a fishing village) and a trip to Bokor national park, some 1000 meters above sea level. The park, unfortunately, was wreathed in cloud and rammed full of Khmer's out picnicking for the new year, so this was less than edifying. Mind you, any tour which starts with the driver announcing he needs to chug a red bull as he was blind drunk the previous evening probably isn't going to go well.

I did pick up a kilo and a bit of pepper whilst there which should keep me going for a bit.

Kep

28/01/14 to 29/01/14

From Phnom Penh it was on the bus down to quiet little Kep an old colonial era seaside town.

Spent time here just relaxing, bit of sunbathing until getting a tuk tuk the 20km or so to Kampot

Phnom Penh

26/01/14 to 28/01/14

Long bus journey to Phnom Penh: slight mix up with the tickets meant our tickets were actually for a bus two days hence. Kept schtum though and kept our seats... Unlike the 10 or so people who were sitting on little stools in the aisle. After a trip like that sundowners at the Foreign Correspondents Club rooftop bar were called for. Doubly in fact due to happy hour.

Serious touristing the next day, literally, with a visit to the Killing Fields and S21. Very moving places that leave on in a very sombre mood. Three million out of a population of eight million were killed during the Khmer Rogue regime. Many were starved or literally worked to death, others executed at various sites. A Khmer Rogue motto was "If you're killing the you need to pull up the roots", which is why there was a tree there where babies brains were dashed out. Chilling stuff.

S21 was the unit for "specials", where party members or other noteworthy prisoners would be tortured into making a confession before being killed. 20000 went into it. Seven came out alive.

Battambang

24/01/14 to 26/01/14

Bused it down to Battambang and on the way had the pleasure (and I do mean that) of watching what appeared to be the Chinese equivalent of a Carry On film set I the wild west.

Battambang (pronounced Bat tam bong) is Cambodia's second largest city and it was good to while a day or two away. Went to the circus at the Phrae Ponlek Seplak, a training establishment for orphans which is similar  to the Cirque d'Soliel. Well worth the time, absolute top class entertainment.

Also fitted in a cookery lesson, a trip to Cambodia's only vineyard (mmm, turps!), a ride on the bamboo train (not a euphemism rather an innovative local use of disused rail tracks involving a bamboo platform, two bogies and a 6hp engine) and a trip to a monastery. Oh, also had one of the best meals I've had in years, true gourmet cooking at a tenth the price you'd pay in the UK!

Pictures to come when I've got WiFi