Tuesday, March 27, 2007

Healthy Travel - Plan Ahead

Although less than 1% of travelers require hospitalization, 70% of those traveling in less developed countries report an illness during their trip. Here's your check list to help prevent many of the illnesses.

Before you take off:

1. Vaccines.
-- See your doctor 4-6 weeks before your date of departure. Bring any immunization records that you may have to your visit.
-- Vaccine recommendations vary by country. Here are the links for India, China, Brazil, and Ghana. For other countries check the CDC site. Europe, Australia, Canada, and USA do not need any further vaccines than what are recommended during routine health care immunizations.

2. Prescription medications.
-- If you are going for an extended period of time you may need to contact your insurance company to get approval for a longer course of your medications such as birth control pills, allergy medications, or inhalers for asthma.
-- Antibiotics such as Cipro for diarrhea type illnesses are useful. Azithromycin can be used for respiratory or skin infections. It can also be an alternative for Cipro.
-- Epinephrine kit if you have severe allergic reactions to bee stings, food or drugs is necessary.
-- Sterile needle/syringe kit if traveling to an area where the sterility of instruments may be in question.

3. Over the counter medications.
-- Loperamide (Imodium) for diarrhea.
-- Diphenhydramine(Benadryl) for allergic reactions, motion sickness, nausea, and as sleep aid.
-- Loratidine (Claritin) for allergic reactions. Lasts longer than Benadryl and is not sedating.
-- Hydrocortisone for skin reactions.
-- Sudafed for congestion, especially if before a flight.
-- Acetominophen(Tylenol), Ibuprofen(Advil) or other anti-inflammatory medication such as aspirin for pain, fever, joint swelling.
-- Metamucil for constipation.
-- Medical kit including a thermometer, band aids, antibiotic ointment, a roll of gauze, tape, and small scissors, oral re hydration salts such as CeraLyte for severe dehydration, hand sanitizer gel or towelettes, tweezers, and extra pair of glasses.

4. Protective gear.
-- Mosquito repellent. 30% DEET containing repellents are recommended for adults. Read here for more details .
-- Proper clothing. Sporting good stores such as REI have permethrin permeated clothing as well as special materials which allow more comfortable temperature control.
-- Sun protection. SPF of 30 is recommended by most dermatologists. Read here for more details.
-- Condoms if you plan to be sexually active but please be aware that they are not 100% protective.

5. In case of pre-existing medical conditions.
-- Pregnancy. Most airlines don't allow travel after 35 weeks of pregnancy. Pregnancy by itself is not a contraindication to travel. Please check with your obstetrician if you have had any complications during your pregnancy.
-- Asthma and respiratory diseases. If your condition is well controlled then there should not be any difficulty with travel. If you are breathless or cannot walk 50 meters (164 ft.) then you should seek medical advice before travel. During take off, the slight drop in oxygen pressure may cause problems for certain chest conditions.
-- Diabetes. Meals should be arranged with airline before travel. During the trip, stay on home time with regard to medication regimen, but after landing adjust to local times.
-- Heart disease. In general if you are able to walk up a dozen stairs then you should not have any trouble on a flight. If you have had a recent heart attack or stroke then you are advised not to fly without consulting your doctor.

On the plane, train, or automobile:

1. Gas.
As cabin pressure falls, the air in the intestines expands by as much as 25% and causes bloating and discomfort. Avoid carbonated drinks, and eat and drink in moderation during a long flight. If you have a severe problem with gas, then you can try over the counter medications which contain simethicone such as Gas-X.

2. Motion sickness.
Eat small but frequent snacks to reduce nausea. Scopolamine (in patches or pills) and medications for nausea and vomiting such as promethazine may be prescribed by your doctor.
These medicines do cause drowsiness and should not be taken with alcohol.

3. Blocked ears.
Can be relieved by swallowing, sucking on hard candy, chewing gum, or holding your nose and blowing. Sudafed tablets and Afrin nasal spray can also help relieve the blockage if taken ahead of time, about 30-60 minutes before take off or landing. If you suspect an ear or sinus infection before your trip, consult your doctor so to avoid the possibility of a ruptured ear drum. There are also pressure-regulating ear plugs which decrease the pain and are sold at most drugstores.

4. Blood clots in the legs (Deep vein thrombosis).
Please read this link for instructions on staying well hydrated and how to exercise the legs to avoid these clots which can lead to serious complications and even death.

5. Stress/fear of flying.
-- Relaxation techniques. Close your eyes and breathe in slowly through your nose and then slowly breathe out through your mouth. Repeat for 10 minutes. Picture yourself in a place such as a tropical beach and concentrate on relaxing each part of your body individually such as hands, arms, shoulders, back, stomach, legs, etc.
-- Anti-anxiety medications such as Ativan (lorazepam) or Klonipin (clonazepam) may be more immediately effective if your symptoms are so consult your doctor about these medications.

6. Dry eyes/contact lens.
Frequently apply wetting solutions to the eyes. You may also consider carrying an antibiotic eye drop containing a quinolone such as Cipro or Levofloxacin.

7. Heart burn.
Large meals followed by prolonged sitting and an increase in gas can worsen esophageal reflux. Over the counter medications such as Pepcid, Zantac, or Prilosec help relieve the symptoms. Ideally they should be taken before the meal. Maalox and Mylanta are faster but shorter acting and may be taken after meals. Try to eat small but more frequent meals or snacks. Avoid alcohol and caffeine.

On arrival:

1. Jet lag.
It can take 1 day to recover for each time zone that is crossed. Most commonly prescribed medication to help with sleep is Ambien. Melatonin may also be used but its effects are not as guaranteed. It is taken 5 mg per day at 6 pm starting 3 days before travel and continuing for a total of 7 days. Bright light therapy may be helpful as well.

2. Safe Food and Water.
The CDC has a detailed site on this subject. Please see the above link. The basic rules are drink bottled water, and don't eat it if you can't boil it or peel it.

3. Diarrhea.
Most common type of illness encountered. A general recommendation is that if diarrhea occurs, let it pass during the first 24 hours. However, if the diarrhea lasts more than 24 hours or if it is associated with blood or fever, then take the antibiotics such as Cipro.

3. Altitude sickness.
Symptoms include headache, fatigue, and insomnia. These may occur at any altitude above 5000 feet, but are more common at 8000 feet. The definitive treatment is to descend, but there are medications such as Diamox which may help relieve the symptoms.

4. For Medical emergencies.
-- The International Association for Medical Assistance to Travellers (IAMAT) publishes a booklet listing English speaking doctors and facilities worldwide.
-- The Bureau of Consular Affairs website (http://www.travel.state.gov/) has a list of doctors and facilities compiled by embassies in different countries.
-- Of course the local hotels can refer you as well.

5. What about the bird flu?
In general, your risk of exposure is very low as long as you avoid bird markets or any other areas which are high in bird feces. It is safe to eat well cooked poultry. Read here for bird flu basics. There are no vaccines for bird flu yet.

6. Do I really have to take the malaria pills?
Yes, if you are traveling to a high risk area - listed from highest to lowest risk areas - Sub-Saharan Africa, Oceania, India, Southeast Asia or Latin America. Although Sub-Saharan Africa is visited by less than 2% of U.S. travelers, this region accounts for 80% of malaria cases reported among U.S. travelers. The CDC reported a 25% increase in cases of malaria in Americans from 1998 to 2000. Throughout history malaria has killed more people than all wars and plagues combined.

Helpful websites:

Traveler's Health
MD Travel Health
WHO on International Health

References: Please see above links. International Travel Health Guide.


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Vijesh said...

hi Doc,
I read your posts at frequent intervals. I'm from Bangalore, India. I got a query. I have planned to make a trip to the nearest theme park here. Its loaded with lots of water rides and land rides. Please do help me out in precautionary things I could do to not get affected from those chlorinated water.


Dr. Taraneh Razavi said...

Hi Vijesh

Thank you for reading my posts. Although I cannot give individual advice I can say in general that as far as I know short term exposure to chlorinated water in that setting should not be harmful. However, if one has hypersensitivity syndromes such as asthma, allergies, or skin conditions such as psoriasis or rash then they should consult their doctor. Otherwise just try to avoid drinking a lot of the water during those wild rides :)
By the way sun protection with sunscreen, hat, and glasses is important during these theme park jaunts. It is also important to stay hydrated and drink lots of "non-chlorinated" water.
Have fun.

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Mark said...

In the UK, there are recommendations for each country you want to travel to. We got all our injections donw for free also, from our nurse at our GP.
Also beware that your travel insurance may not cover you, if you have not followed through with the right proctection, for your travel.

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Andrew said...

All very good advice. Thanks for putting it all together, it makes a handy checklist for anyone preparing to travel. Especially the information on where to go in an emergency. I'm never that worried about general illness, but I always worry about a real medical emergency in a foreign country.

beartoes said...

Very good information doc. I really enjoyed it. Some of the tips that you gave I had never heard of before, but will in the future. I usually get asthma and allergies allergy treatment is the real problem. Some information on this would be great.

Anonymous said...

hello doctor...i will be traveling to varanazi at the ganghes and wondered if i should be concerned about malaria in jan and feb in that part of india? malaria pills are quite scary to me...thank you k