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Dr. Minocha  is a practicing gastroenterologist and author of "Natural Stomach Care: Treating and Preventing Digestive Disorders with Best of Eastern and Western Therapies"

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Americans are traveling far and wide to newer and more exotic destinations. With these adventures come the risks which we should all be aware of. 

Travel

A variety of problems may be encountered during travel to the destination before you even get there. Patients with chronic heart failure and chronic lung disease may encounter breathing difficulties in the plane due to the cabin pressure which is equivalent to an altitude of 5000 to 8000 feet above sea level. 

Motion sickness may occur. Position yourself where the motion is the least, e.g. middle of ship or over the wings in the planes. Avoid reading and alcohol intake. Consume small amounts of simple foods and beverages. Avoid any oral intake for short travels.

Those susceptible to motion sickness may take other preventative medications like diphenhydramine (Benadryl), scopolamine or meclizine, an hour before departure. Dermal patches are available for some medications. Always consult your doctor prior to use because many of these medications may cause significant side effects especially among senior citizens.

 Coach Class syndrome occurs as a result of being boxed in a cramped coach class seat in the plane for an extended period of time. This may cause clots in the veins. Deaths have been reported. Domestic air carriers have been slow to respond to this problem, whereas international carriers frequently show videos of exercises that you could be doing while sitting in the seat.

Except during food service, flight attendants do not mind you walking around. Get out of your seat and walk around every one to two hours. A glass of water may be preferable to an alcoholic drink. A tablet of a blood thinner like aspirin prior to embarking on travel may reduce the risk. Check with your doctor first!

While filtered air systems present in the plane do minimize infections, transmission of respiratory infections from a person coughing and sneezing close to you is possible. Serving contaminated food in the plane is possible but rare.

Altitude sickness

Altitude or mountain sickness may occur among mountain climbers as well as those landing at high altitude airports. Partial pressure of oxygen decreases with increasing altitude and as many as 20% of travelers ascending above 8000 feet in less than a day develop symptoms. Children are at the greatest risk. Ascending slowly helps, but the safe rate of ascent varies among individuals. The best treatment is to descend to a lower altitude. There are no tests to predict who may be at risk.

 Jet lag

Prolonged air travel across time zones disturbs biologic rhythms and may result in jet lag. It is more common among senior citizens.

 

Your doctor may prescribe a mild sedative like Ambien to minimize the problem. Melatonin taken in the evening at your destination may help reset your biologic clock. 

Immunizations

Vaccination against a variety of diseases like Hepatitis A, Yellow fever, cholera, polio, typhoid, meningitis, rabies etc. is available and should be undertaken based on your travel destination. Immunization requirements change frequently, so be sure to check before embarking on travel. 

Mosquito borne-diseases

Individuals traveling to tropical countries of Asia, Africa, and Central America are at risk for developing mosquito-borne diseases like malaria, yellow fever, and dengue fever. Use of protective clothing, insect repellants, insect sprays in the living surroundings, as well as mosquito nets during the sleep help reduce the risk.

Apply insect repellant to the exposed skin, but away from eyes and mouth. Do not allow kids to apply it themselves. Do not use it on the hands of small kids. Although not proven to be absolutely safe, DEET is perhaps one of the better insect repellants. Use products containing less than 10% DEET and follow label directions carefully. Products containing soyabean oil and PMD are perhaps the best among botanical repellants.

Use of chloroquine pills can reduce the risk for malaria. In countries with chloroquine resistant malaria, mefloquine and Doxycycline are reasonable alternatives. Chloroquine and mefloquine are administered weekly whereas Doxycycline needs to be taken daily. Start Chloroquine or mefloquine 1-2 weeks before travel and continue for 4 weeks after returning. Doxycycline can be started 1-2 days before travel to destination. 

Traveler's diarrhea

Traveler's diarrhea is a concern when traveling to any area with new and different kinds of foods. The more adventuresome your culinary tastes, the greater the risk. Contaminated foods are bigger source of traveler's diarrhea than the contaminated water.

Drink boiled water or fluids that are reliably bottled. Bottled or canned carbonated beverages are usually safe. Do not ingest ice cubes or tap water. Portable filters are not recommended. Eat hot cooked foods. Avoid salads, uncooked vegetables and un-pasteurized milk.

Prophylaxis for traveler's diarrhea although effective, is not routinely recommended. The diarrhea is usually self-limiting. Treatment involves drinking plenty of fluids and an antidiarrheal medication, e.g. loperamide (Imodium). Addition of Peptobismol may help. Antibiotics like Cipro may be needed. Frequently only one dose of Cipro may be sufficient, although it may be needed for 3-5 days. Talk to your doctor first. Many doctors give their patients such medications to take with them for use as needed.

 

Seek medical help immediately if you develop bloody diarrhea or fever, or if diarrhea does not resolve with simple measures.

Sun exposure

Do not forget the problems related to sun exposure when you are enjoying the beautiful weather. Open water and snow skiing exacerbate the risks of sun exposure. Wear hats and other protective clothing. Use sunscreens with a sun-protective factor of 30 or higher. Apply it 30 minutes before exposure to sun. Don't be miserly on the lotion. An average bikini-clad woman requires as much as a full ounce of lotion to cover her body. 

Miscellaneous

Air travel up to 36 weeks of uncomplicated pregnancy is no problem. Be sure to check with the doctor first. Wear the seat belt below the abdomen.

Metallic component of pacemakers and orthopedic devices may activate security systems. Be sure to take a letter from your physician. Patients with chronic illnesses should wear medical identification bracelet or necklace.

While people tend to focus on preventing infections, they may not realize that traffic accidents and drowning are a major cause of fatalities amongst travelers to foreign countries. In many developing countries, people drive like crazy and rules of the road are seldom followed.

Many insurance plans may not be valid in foreign lands. Travel insurance plans are an option and are available through travel agents. Check the U.S. State department for any traveler advisory for your destination prior to departure. A consultation with the local travel health clinic is a wise investment. Contact your state health department or nearby medical school for information about such clinics.

 
 
 
 
 
 
HELPFUL HEALTH TRAVEL WEB-SITES

http://www.cdc.gov/travel/index.htm

  >>Still Have Questions?? Join the Discussion    >>Click Here to Read About Dr. Minocha

 

This is meant to be an informational exercise and NOT a medical consultation. Your doctor is the only one who can best assess your situation and offer you medical advice.


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