That Time When I Got Zika

Aedes_aegypti Muhammad_Mahdi_Karim

Why traveling to the Dominican Republic was so problematic

Two years ago the Dominican Republic was a hotbed for the mosquito-borne virus Zika. As you may know, Zika is responsible for causing severe birth defects in babies who are exposed to the virus while in their mother’s womb. When I arrived to the Dominican Republic we knew that we would have to put off trying to get pregnant for at least two months starting from the day we left- and that guideline was only if neither of us showed symptoms. If we did have symptoms, and depending on who had them, that period of waiting could increase to 6 months.

However, when I left the USA I also left the Zika hysteria that had consumed the nation behind. In the USA updates and warnings were featured in the news daily, creating the impression that everyone was at risk all of the time. While the risks were real to those who were exposed, the vast majority of Americans never would be. Conversely, there were ongoing outbreaks all over the DR, but very little was communicated to the local population about their status.

Getting a little too “caught up in the moment”

Arriving to the DR (where hardly anyone talked about Zika) and being thrust into medical emergencies and life and death decisions, Zika’s looming threat lifted as well as the concern for waiting to try. Of course it didn’t help that MH’s family members (who had nothing but the purest intentions) would frequently ask when we would start a family, and that EVERYONE had children around us. But when I would voice my concerns about Zika, I wasn’t met with the same ubiquitous anxiety and concern that I had experienced at home.

So as worries faded and the weight MH and I felt from navigating one crisis after another increased, I gradually loosen my stance. Zika seemed like a faraway concern when we had so many other problems to confront on a daily basis. It was a pressure cooker situation, and rather than the stress crack our marriage, it fused us together. And in a city where you can’t do something as simple as go for a run, the best way to release stress was through intimacy. So MH and I figured, “why not just see what happens?”

My first Zika symptoms

After being in the DR for five weeks I decided to head back to the USA for Father’s Day and my father’s birthday. Two days after arriving, I went to the beach, and when I got back I noticed a slight rash on my face and chest. I have lost count of the number of times I have broken out in a rash of some sort after traveling- especially when sun and salt water in the mix. It wasn’t itchy, but my skin did feel sensitive. I wondered if it could be Zika, but at the time I chalked it up to hives from the stress of the trip. That night I took an antihistamine and went to bed.

The next morning I awoke and the rash was all over my body. I felt tired and a little bit of a mental fog, and at this point I knew it was something more. I took a picture of my rash and sent it to MH, who forwarded it to his family. His aunt, who is a doctor, confirmed that it looked like Zika so I started making the calls.

Trying to get tested for Zika

I searched for Zika test locations in New Jersey, but all I could find was a Zika hotline. When I called, I was told the test was only processed at one lab in the state, so I would need a doctor’s referral. The operator recommended that I call a local hospital, so I did. The hospital stated that the only way to be seen was via the emergency room and to be evaluated by the infectious disease doctor on staff. At this point, I was informed that I may or may not be given the test. Since I had already spent a couple of hours researching the tests and their reliability, I knew that the tests available were notorious for both false positives and negatives. Depending on the test used, they also picked up on whether the patient had Dengue or Chikungunya exposure. I decided against spending thousands of dollars to *maybe* be given a test that *might* be accurate. My concern at this point was knowing if I had something else that could be highly contagious.

An hour later I went to a walk-in clinic and was seen by the doctor there. She evaluated me, and ruled out any other infectious disease. I had no fever, the rash was consistent all over my body, and my eyes were clear of any symptoms. She said the only other thing it looked like was Lyme disease, but the timing of my symptoms didn’t align with when I arrived to the USA. I asked if she could give me a prescription for the Zika test, and it became evident that I knew more than she did about the disease and the resources available. I sat on the exam table for several minutes as she researched Zika on her computer. Her diagnosis: yes, it looks like Zika. But to be sure, I should call an infectious disease specialist on the following business day.

The next day I called the infectious disease specialist referral, and was informed that their first available appointment was in two months. Since testing needs to be performed within the first two weeks of the onset of symptoms, it was pointless to make an appointment. I was in disbelief that despite the amount of national attention that was focused on this disease, our healthcare system was so poorly prepared. Literally no one knew what to do with me.

My Zika symptoms: rash, swelling, and aches

I was fortunate that I didn’t have the more severe Zika symptoms, such as a fever or conjunctivitis. However, by this point my fingers began to swell and my hands looked really cartoonish. Then the following day my feet swelled and my joints began to ache. My rash lasted less than a week, but my feet and knees continued to be alarmingly tender when I would walk first thing in the morning; it felt like the tissue was super inflamed. Thankfully after three weeks I felt normal again.

Officially having to wait

Although the medical professionals that I spoke with were fairly confident that I did contract Zika, I was never officially diagnosed. Therefore, I was treated as if I did have Zika in the sense that I would have to wait at least two months to try to get pregnant. I would also have to follow the same guidelines has non-infected people and have to avoid re-exposure for as long as MH and I were trying. Based on research at the time, it was believed once you were infected you developed immunity; however, there was so much that the medical population didn’t know about the virus: Were there different strains? Was it evolving? Were you really immune?

At the time, I assumed once we passed that two month mark I would be pregnant soon after and we wouldn’t have to worry about Zika for some time. I never would have guessed that two years later Zika would be a reason for why we would have to pursue IVF.

Photo Credit: https://en.wikipedia.org/wiki/User:Muhammad_Mahdi_Karim

The Two Year Wait – The Third Year

What was supposed to have been waiting two years to try to start a family gradually slipped into three. After MH and I got married in December of 2014 we had planned on waiting another 6 months or so to start a family of our own. However, around the time that this was supposed to happen we were dealt with several urgent and life altering challenges that had to be addressed before we could move forward. I had shoulder surgery…our home sustained a large amount of water damage from a neighbor above… MH’s parents came to visit, and we could not host them I our home, so we paid for what turned out to be a two month stay in a nearby hotel… add on an emergency room visit for my father-in-law and another shoulder surgery for me, and by the end of 2015 we were physically exhausted and in rough financial shape. My baby fund- which I had diligently nurtured over the past two years and had defended to the very end- had been depleted. We both felt defeated, and in early 2016 our conversations about starting a family were heated and emotional. MH didn’t see how it was possible for the foreseeable future, since he wasn’t willing to raid our retirement fund to provide for a family. I was heartbroken, and for the first time, I questioned whether it would actually ever happen.

Looking back, I wasn’t physically ready to have a child. I was still in weekly physical therapy sessions for both shoulders, and every morning I would have to “warm up” with exercises and stretching to prepare my body for the day. My work, which is 100% on the computer, would leave my arms tingling and numb after typing for a short amount of time. Every day was exhausting, and even as I improved physically, mentally I still felt stuck. My perception of myself was as someone who was incapable and hindered; the pain from my physical injury had tainted my attitude and outlook.

In January of 2016 we got some concerning news from the Dominican Republic about MH’s parents. His father had fallen, and due to his battle with Rheumatoid Arthritis and his heart condition, he was having potentially life-threatening complications. Soon after, MH’s sister contacted us with news about my mother-in-law, who is a breast cancer survivor. She had discovered a lump in her breast and was going in for a scan. MH and I feared and were preparing for the worst.

If you were pregnant, trying to get pregnant, or even thinking about getting pregnant, then you know that January of 2016 was the beginning of Zika hysteria- and for good reason. It was discovered that babies across South America were being born with severe birth defects from women who were infected with the Zika virus during pregnancy. Being that Dominican Republic was one of those areas effected by Zika, we were faced with an additional set of constraints. From the moment that MH returned from the Dominican Republic, we would have to wait 6 months before trying to start a family. It felt like at every turn we were given another reason why our family plans must be deferred.

At the end of February MH and I flew to Miami to meet his mother for a PET scan to determine the severity of her cancer. When we received the results, we were ecstatic to learn that she was only Stage 1, with a possibility of being early Stage 2. With the results in hand, we sat down and talked about next steps. We knew she needed help caring for MH’s father, since the Dominican Republic lacks the same medical support systems that you would find in the US. There are no official home care programs; everything is done by family. And since my mother-in-law would have radiation appointments to keep, she wouldn’t be able to spend hours navigating the gridlock traffic of Santo Domingo taking my father-in-law to doctor’s appointments or picking up medicine from the pharmacy. She asked for MH to come and help, and of course, he said he would.

Coming back to San Diego after the Miami trip was nerve wracking. We knew from experience that the severity of these types of situations weren’t communicated wholly, and that MH’s father would say “I’m fine!” when that was not the truth. I remember crying on the couch while home alone one night, wondering what the other side of this would look like… the amount of debt we would incur… the sacrifices we would make before we could take the next steps in building our future. In a stupid act of desperation I completed one of those Facebook games. You know, the ones where they analyze your profile (e.i. you give them access to your personal information) and return some revelation about what your sprit animal is, or which celebrity is your doppelganger.  This particular “game” was “receive a future postcard from yourself”.  The algorithm must of have had the capability to measure hopelessness, because the words that I received were the words that I most desperately wanted to believe: “The thing you are worrying about so much right now, doesn’t happen. Life is good in the future and you’re such an amazing person. Just remember to be happy!” While I wouldn’t choose those words exactly, it really did feel like an older and wiser version of me was telling my current self not to drive myself into a frenetic state of anxiety over hypotheticals built upon hypotheticals. A calm washed over me, and I still keep a screen shot of that “postcard” on my phone today.

About three weeks later MH went to see his parents in the Dominican Republic, and immediately upon arrival he called to tell me that his father’s condition is worse- much, much, worse- than what had been conveyed. Within two weeks, his father went into intensive care and we were preparing for his demise. Since MH works remotely, he was always able to work from the DR during his visits. However, his company recently adopted a new policy and it was no longer allowed. The only option was for him to take unpaid family leave.

This time of our married life was terrifying. My project was winding down, and there wasn’t additional work in the pipeline. We were prepared to lose one income, but not two. After MH had been away for four weeks, we decided that the only option we had was to rent out our home in San Diego and for me to come join him in the DR for several months. He was in the process of losing one, and potentially two, of his parents. I felt like I was losing my dream of a family and our future. We both wondered to one another whether our marriage would survive this.

I had three weeks to move our personal belongings out of our condo, fix various cosmetic issues in preparation for getting our place ready for rent, wrap up my doctor’s appointments- all while working full time. I wasn’t sleeping, nor was I eating. The non-stop activity, along with the pressure to rent our condo to cover our monthly expenses, left me enervated and fragile. Just two hours before I left for the airport I finished cleaning, putting our belongings in storage, and packing the 5 months worth of clothes and personal effects that I would need while out of the country. When my husband picked me up at the airport in Santo Domingo he immediately acknowledged my drawn face and the weight I had lost. He filled me in on everything that had transpired that he couldn’t discuss on the phone on the drive to his favorite bakery, where he ordered me the largest slice of chocolate cake I have ever seen. Despite all of the worrying over the last six weeks I felt with certainty that now that we were together, everything would be fine. And in terms of our union, thankfully I was right.