As a traveler engaging in the providing health care to others, it is sometimes easy to forget to take care of yourself. However, if you are sick or injured, you no longer are a help to others not to mention it is not fun to be sick away from home. These links help you find information on:

• Immunizations needed where you will be traveling
  • CDC Vaccinations http://wwwn.cdc.gov/travel/contentVaccinations.aspx
  • International Association for Medical Assist
    http://www.iamat.org/
• Tips on keeping yourself healthy abroad
  • CDC Travel Health www.cdc.gov/travel/default.aspx
• Safety and illness information for water and food
  wwwn.cdc.gov/travel/contentSafeFoodWater.aspx

Did you know??

1. Air Pressure: Boyle’s Law states that as atmospheric pressures fall (with rising altitude as in flying), gases expand. Therefore, problems mainly develop from gases trapped in spaces such as sinuses, middle ears, teeth (who knew), and abdominal cavity. For most healthy people, minor abdominal or ear discomfort is manageable with yawning, sneezing, swallowing, chewing gum, or gentle valsalva by closing nose with thumb and finger and exhaling gently with mouth closed. For those with colds or prior difficult experience try:
   1. Afrin nasal spray 3 min prior to takeoff
   2. Oral decongestant like Sudafed
       
2. Blood Clots: Virchow’s Triad for cause of blood clots includes venous stasis, hypercoaguability, and endothelial injury to trigger clotting. Flying may incorporate all of these in the triad with:
   1. Venous stasis with prolonged immobilization
   2. Concentration of the blood due to the relatively low humidity of the cabins producing dehydration
   3. Endothelial injury by compression of the popliteal veins against the edge of the seat
   4. Decreased oxygen tension and ambient cabin pressure may impair the body’s ability to lyse clots or may induce clotting
   5. Accumulation of fluid or edema in the legs may compress veins and may further clotting

Do not fear though overall incidence is EXTREMELY LOW… here’s what you can do to prevent DVTs:

Stay well hydrated – one glass of water every 2 hours

Avoid alcohol and salty snacks

Periodically move about the cabin

Stretch or exercise lower legs in seat – try doing alphabet with ankle or “pumping” feet

Wear loose fitting clothing

Avoid crossing legs

Those at “high risk” include those who have a prior history of DVT, a clotting disorder, cancer in previous 2 years, limitations of mobility due to bone or joint issue, recent surgery, obesity or large varicose veins. “High risk” individuals should: strongly consider purchasing and wearing Scholl’s Class I Flight Socks or US Equivalent Travel compression socks. Consider with medical consultation the use of enoxaparin.

O’Neil, Edward. Practical Guide to Global Health Service. American Medical Association: 2005

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• “boil, peel, bottle”
• Don’t drink water not in a sealed bottle or purified by boiling, filtration or iodine

Treatment:

• Toilet paper in a plastic bag
• Rehydration – match stool output with fluid input, oral rehydration packets, or create ral rehydration solution with 8 teaspoons sugar (handful) with 1 teaspoon salt (pinch) in 1 liter clean water, pedialyte
• Loperamide (Immodium): 4mg after first loose stool and 2mg after each subsequent loose stool to total of 16mg daily – avoid if associated with bloody stools or fever
• Floroquinolone in adults or Bactrim in pregnant and children
• Seek help if no improvement with antibiotics

O’Neil, Edward. Practical Guide to Global Health Service. American Medical Association: 2005

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• Long shirts and pants for evening activities
• Spray clothing with permethrin. Or you can purchase BuzzOff clothing.
• Use bed netting, which can also be sprayed with permethrin.
• Use DEET = gold standard. 4.75% DEET lasts 1.5 hours of protection, 6.65% DEET lasts 2 hours. 20% DEET lasts 4 hours, 23.8% DEET lasts 5 hours.
• Chemoprophylaxis:
  • Check CDC or WHO for up to date recommendations
  • Chloroquine is drug of choice for chloroquine sensitive areas =
    • Mefloquine (Larium) – once weekly dosing is easy, contraindicated in people with history of depression, psychosis, or other major sychiatric problems, may cause disruptive nightmares or vivid dreams. Not to be used in Thailand, Cambodia, Myanmar (Burma) due to mefloquine resistant areas on borders.
    • atovaquone-proguanil (malarone) - well tolerated, expensive and daily dosing, may be good for shorter trips
    • doxycycline – daily dosing and may cause photosensitivity. For the Kenya trips, Doxycycline (Vibramycin), is not effective as the other medications and therefore is NOT currently recommended.

O’Neil, Edward. Practical Guide to Global Health Service. American Medical Association: 2006

• Antibiotics (e.g. Ciprofloxacin, Bactrim, Metronidazole) – consultation may be needed to know when to properly use these
• Acidophilus and Lactobacillus can be considered – one brand that has come Physician recommended is Culturel (can be found at Walmart) – most are better refrigerated but this one is ok not refrigerated
• Muscle relaxant
• Sleeping pills (over the counter or prescription) may help with jet lag or insomnia but careful with “hangovers”
• Anti-diarrheal (Bismuth, loperamide) – safe and effective for mild to moderate diarrhea
  • Loperamide: 4mg after first loose stool and 2mg after each subsequent loose stool to total of 16mg daily – avoid if associated with bloody stools or fever
• Anti-nausea meds (i.e. prochlorperazine (Compazine) Promethazine (phenergan) or Ondansetron (Zofran – more expensive))
• Fiber laxative (i.e. Metamucil, Konocyl)
• Hemorrhoid wipes – i.e. tucks medicated wipes for diarrheal days
• Anti-gas medication
• Antacid
• Antihistamine (i.e. Benadryl -topical and oral – can be used for allergic reactions and to help with bug bites)
• If you have a history of severe allergic reaction an Epi-pen is recommended
  Motion sickness pills (i.e. Dramamine)
• Cold medication
• Antifungal cream or spray, antifungal for Tinea cruris for men, something to treat yeast infections for women
• Antibiotic cream
• Variety of bandaids, ace wraps or braces for existing joint problems
• Sunscreen
• Burn ointment (i.e. aloe)
• NSAIDS (i.e. Ibuprofen)
• Acetaminophen (for fevers and pains)
• Multivitamins
• Q-tips
• Tweezers (checked luggage)
• Prescriptions and any other items that you use on a regular basis (including feminine hygiene products) – also any medications that would be used for any chronic conditions you may have even if you have not had a problem for a long time – i.e. Asthma – come prepared with an inhaler, etc.

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