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April 25, 2010



I'll never go to a third world country - much too risky for me - but I'll admit the month I spent backpacking in Europe was, in large part, a way for me to say "screw you" to RA and my recently implanted defibrillator. I imagine some of that is going through these patients' heads, as well.

That said, it was complicated enough carting Enbrel around, avoiding metal detectors and having to know the location of a cardiac unit in every city. I can't imagine how difficult it would be outside the developed world.


Patients born in Europe could have been vaccinated with the live TB vaccine in their childhood, which causes a significant fraction of them to still test positive in tuberculin test response in adulthood. I know this because I had to take TB test form my Green card, and I had to go to hassle of proving that I do not have TB even though my tuberculin response was positive. They really wanted to treat me with cycloserine and rifampicine for half a year, no matter that 5% of patients develop nasty liver reaction to the treatment, and that treatment ruins the efficacy of the TB vaccination...


Good point, and one I recently had to think about when a vasculitis pt announced a trip to Haiti.

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I have no idea what the situation is in the vacation regions of Thailand. It may be fine for all I know, but what I have noticed is that the traveling patients of mine don't know either.

Manohar Singh

How could Santiago, who subsists on occasional handouts from kind café owners or, worse, imaginary meals, wage the terrific battle with the great marlin that the novel recounts?

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