When a doctor calls you after doing blood work, it’s never a good thing. It certainly wasn’t when my new primary care doctor called me in June, three months into our trip.
We were home for a few weeks for a friend’s wedding, and I took the opportunity to see my doctors, get my A1C tested and check in on everything else. My doctor decided to test my liver, since I was taking doxycycline for malaria prevention in South America. I only needed it for my visit to the Amazon, but you’re required to take doxycycline for two days before you reach a malaria zone, and then 30 days after you leave. So in total, I took doxycycline every day for about six weeks. This kind of long-term doxycycline can create a rise in liver function, since the liver is the organ that clears most medications.
So the doctor called. And she quickly got to the point: “Unfortunately, your liver tests came back elevated. It’s not a big deal right now, but we will need to follow up on it.”
Needless to say, this is not what I wanted to hear. She couldn’t conclusively say it was the doxycycline, but she sent in order for me to get the test re-done. I waited two more weeks and I stayed far away from alcohol, figuring that reducing the wine intake couldn’t hurt.
I got the results of the second test when I was in Namibia, the night before we were going to start our first safari. The results were higher than the first test, and my doctor started talking about running a lot of other tests to rule out infections, all of which sounded rather scary.
It’s at this point that I started to really worry. To me, a month after stopping the medication was a long time for my results to still be high. And the results were higher than the first test! What if it wasn’t the doxycycline? What if it was something else?
Unfortunately, there was nothing I could do for 10 days. Our safari was throughout the wilderness of Namibia and there was no time to figure out how to get blood work done. So I put a smile on my face and tried to not think about it.
When we got to Cape Town, South Africa, I spoke to my doctor again. She did not feel comfortable ordering the blood work internationally, without the ability to see me for an appointment. While this made it tougher for me, I saw her point.
That left me seeking out a doctor in Cape Town. I ended up getting referrals from both our hostel and the hospital. Within two days, I had an appointment with a reputable doctor. I went in for a 9 am appointment on Tuesday. The South African doctor applauded me for caring enough to follow-up on this, but said that she really did not feel concerned about my liver results. She said the results were so barely elevated to cause concern, and in fact, we ended up spending most of the appointment discussing how my insulin pump and CGM work, since she does not work with those. Regardless, she re-ran the blood work.
I went back the next day to get the results. They were perfectly within range and normal. The South African doctor then said that if she knew I was on doxycycline long-term, she would never have tested my liver in the first place because she would have assumed the results would be elevated.
I’m grateful that my tests are normal, but I have a few take-aways:
- I’ve sticking to Malarone for malaria prevention going forward, rather than Doxycycline. My travel clinic in the U.S. initially preferred that I use Malarone over Doxycycline. They said both were safe, but the Malarone was marginally better, especially considering the diabetes. They couldn’t articulate exactly how the diabetes factored in, and at the time, my insurance did not cover Malarone (which is $5 per pill!), so I went for the Doxycycline. My new insurance does cover Malarone, and I now know that my body doesn’t like Doxycycline, so I’ve switched over.
- Medical care in a foreign country was a lot less scary (and less expensive) than I anticipated. The process of setting up an appointment and getting follow-up answers was simple, and so much less complicated than in the U.S. This makes me feel a bit more confident if I do end up needing a doctor’s appointment for anything diabetes-related.
The medical care also was much cheaper. I paid 500 Rand (~$40 US) for both the initial visit with the doctor and the follow up, and 720 Rand (~$55 US) for the blood work. If U.S. medical care was only that affordable!