Healthy Travels!

By Carol Sorgen

Getting sick is no fun. That's especially true when you're on the road. With summer vacations beckoning, now is the time to learn how to minimize your risk of illness and injury while traveling.

Don't Drink the Water

Even if you have an iron stomach, you may wind up with a tummy upset from local food and water. To avoid traveler's diarrhea (TD), the Centers for Disease Control recommend the following steps:

  • Avoid eating foods or drinking beverages purchased from street vendors or other establishments where unhygienic conditions are present
  • Avoid eating raw or undercooked meat and seafood
  • Avoid eating raw fruits (e.g., oranges, bananas, avocados) and vegetables unless you peel them.

If handled properly, well-cooked and packaged foods usually are safe, the CDC advises. Tap water, ice, unpasteurized milk, and dairy products, however, are associated with increased risk for TD. Instead, choose bottled carbonated beverages, hot tea or coffee, beer, wine, and water boiled or appropriately treated with iodine or chlorine.

TD usually doesn't last long and often resolves without specific treatment; however, make sure you stay hydrated to replace lost fluids and electrolytes. Clear liquids are routinely recommended for adults. If you develop three or more loose stools in an 8-hour period---especially if accompanied with nausea, vomiting, abdominal cramps, fever, or blood in stools---or diarrhea persists despite therapy such as over-the-counter anti-diarrheal medications; you should be evaluated by a doctor and treated for possible parasitic infection.

Health Risks Around the World

Unfortunately, there are more serious health risks than TD. To find out more about health alerts in regions to which you're traveling, visit the websites of the Centers for Disease Control (www.cdc.gov), the International Society of Travel Medicine (www.istm.org), or travel medicine clinics such as Baltimore-based Passport Health (www.passporthealthusa.com), which has posted the following latest travel health alerts on their site:

Bolivia and Colombia-Yellow Fever alert in both countries. Yellow Fever immunization is recommended and travelers should take steps to avoid mosquito bites.

Yemen, Ethiopia, Saudi Arabia, Indonesia-The World Health Organization (WHO) has confirmed cases of polio paralysis in all countries. In 2003 there were only 800 confirmed cases limited to 6 countries. Now 16 countries including Africa, Asia, Middle East, India and the new independent states of the former Soviet Union report polio outbreaks. The risk of importations into polio-free areas remains as long as polio exists anywhere in the world. These cases clearly indicate the need for a polio booster prior to travel.

Dominican Republic-Twenty cases of malaria were reported in persons who had traveled to resort areas in La Altagracia Province from November 2004 to January 2005. In response to the outbreak, CDC recommends taking an antimalarial drug for all travelers to the two provinces, including resort areas. Plasmodium falciparum, may rapidly result in a severe, life-threatening illness if not promptly treated. Antimalarial drugs should be taken. Repellents should also be used.

India-As of May 16, 2005, 303 cases of meningococcal disease have been reported in Delhi with 26 deaths. Majority of cases and all deaths have occurred in young adult population. The National Institute of Communicable Diseases has demonstrated the presence of Neisseria meningitis serogroup A in cerebrospinal fluid obtained from five cases. Most cases have been reported from Old Delhi. Vaccination should be considered for travelers.

China-The Ministry of Health of China reports an outbreak of meningococcal disease in 11 cities in Anhui Province in eastern China. In 2005 62 cases have been reported with 6 deaths. Most of the cases are Neisseria meningitides serogroup C. Travelers should consider immunization with meningitis ACWY vaccine prior to travel.

Brazil & Thailand-Outbreaks of dengue fever are reported in both countries. Over 84,000 cases in Brazil in 2004. In Thailand 22,000 cases reported between Jan-Aug 04. There is no vaccine. Travelers are reminded to take steps to avoid mosquito bites.

Fiji & Malaysia-Media sources have reported cases of typhoid fever throughout both countries. Travelers, especially those staying in basic accommodations should take typhoid immunization and extra food and water precautions.

Senegal-WHO reports an outbreak of cholera in Diourbel region coinciding with the annual pilgrimage to Touba in April, 2005. The outbreak is reported to be spreading to other regions. Travelers should take oral rehydration and appropriate antibiotics along as a precautionary measure.

Managing Your Meds

For more general travel tips, Dr. Glen Stettin of Medco Health Solutions (www.medcohealth.com), a leading national prescription drug benefits manager, offers these solutions for staying healthy while traveling:

Make and Take a Medication List-Keep an updated list of all medications with you at all times, including prescription, over-the-counter (OTC), and any vitamins and supplements. Include the medication, the strength, and the condition you are taking it for.

Have Your Meds Mailed to You - Three-month supplies of medications for chronic conditions can be filled through a home delivery pharmacy and sent directly to a summer home, eliminating the need to switch pharmacies and preventing the loss of important prescription information between different pharmacies.

Ask for Refills or Renewals Before You Leave - See your doctor for a check-up before you leave for the season and ask that your prescriptions be updated with renewals if necessary. This is especially important if you will be moving around a lot, making it difficult to get the prescriptions to you in a timely fashion. If you use a retail pharmacy, refill your prescriptions before you leave to make sure you have a full supply.

Have Contact Numbers Handy - Always carry a list of phone numbers for all of your doctors and your home pharmacy, in case an emergency arises and they need to be contacted.

Dr. Stettin also advises travelers to consider the following tips when packing their medications or while on the road:

Use original containers - Carry your medications in original containers with original labels to prevent anyone from mistaking them for other substances. Also, keep a copy of the prescriptions with you for emergency refills.

Keep your medications close - When flying, always carry your medications with you instead of packing them in a suitcase that will be checked and stored on the plane where you will not have access to them.

Avoid extreme temperatures - In automobiles, do not store medications in the trunk or glove compartment where temperatures may become very hot or very cold. Also, do not place medications on the dashboard or back window, where they may be exposed to direct sunlight and excessive temperatures.

Think kid-safe - If you are visiting a place where children will be present, keep all medications out of their reach or in a locked suitcase. Store your medications in labeled, child-resistant containers. Do not underestimate a child's ability to climb, open drawers and cabinets, or to mistake medications for candy. Make sure a child's parent or guardian is aware of where the medications are being stored.

Take extra medication - Take along more medication than you expect to need for your entire trip. If anything happens to your medication or if you end up staying longer than planned, you can avoid wasting time trying to obtain a refill from doctors.

Dining Sensibly

Staying healthy on vacation also means sticking to a sensible eating plan. Nicole Haywood, M.A., R.D., of the National Institute for Fitness and Sport, and the author of Absolute Beginner's Guide to a Lite and Healthy Lifestyle, has these recommendations:

  • Plan ahead. Don't get trapped by limited, unhealthy choices. Don't resort to fast food and airport snack bar. Bring along a bag of healthy goodies and snacks.
  • Call the airline ahead of time and request a special meal, such as low sodium or vegetarian.
  • Bring a small cooler for road trips. Stock it with low-fat yogurt, whole-wheat crackers, fruit, slices of low-fat cheese, baby carrots, cut vegetables, and water.
  • Vacations and conferences often mean constant access to less than perfect meals. Indulge occasionally, but be sure to balance it out with healthy food choices throughout the rest of your day. Enjoy the fish and chips in London for lunch, and have a broth-based cup of soup and a salad for dinner. Then make the most of pedestrian-friendly cities and go for long walks whenever you can.
  • Start your days with a power breakfast to keep your energy up and your hunger level down throughout the morning. Try cereal with skim milk or yogurt, fresh fruit, and chopped almonds; whole-wheat toast with preserves, a hard-cooked egg or scrambled egg substitute, and fruit or juice; or hot oatmeal with walnuts and dried fruit. These morning menus provide complex carbohydrates, moderate amounts of protein, and a little fat to fuel your body for the full day ahead.
  • Avoid the mini-bars in hotel rooms. High-calorie alcoholic beverages may help you relax, but they also relax your resolve to eat healthfully away from home. Plunge into your bag of healthy snacks and bottled water; or make your own mixer with club soda and fresh lime juice.
  • Leave your emergency food stash at home? Take a few minutes and go to the nearest grocery store or market to get some healthy supplies for your stay. Whole-grain English muffins, fruit, dried fruit, peanut butter, milk, popcorn, granola bars, precut veggies, and low-fat dip are all good staples while on the road.
  • Eat when you are physically hungry. Many people eat while traveling because they are jet-lagged, dehydrated, tired, frustrated, bored or lonely. Instead of using food to manage these situations, go for a swim in the hotel's pool or take a stroll through town. Exposure to bright sunlight can help reset your body's internal clock if you're groggy. Bring some good reading material or stationery and catch up on correspondence.
  • Drink plenty of water. Air and road travel can dehydrate you, making you feel tired, sick, cranky and vulnerable to snack attacks. Aim for eight-ounce glasses of water each day, and more if you are traveling in hot climates.
  • Try to eat at least two fruits and three vegetables daily.

Where to go for Answers

If you have specific questions about your individual travel plans-what vaccinations you should receive before traveling, for example-there are a number of travel medicine clinics that can help you plan a safe, healthy vacation.

At the Center for Wilderness and Travel Medicine at Mercy Medical Center in Baltimore, for example, medical director Michael Zimring, author of Healthy Travels, being released this summer, can discuss such issues as how to avoid sunstroke, hypothermia, and dehydration; what to do if you're pregnant and go into labor while traveling; how to avoid mosquitoes, traveler's diarrhea, venal thrombosis...."These are all topics we discuss with every visitor to our Center," Dr. Zimring said.

The Center offers immunizations for travel, pre-and post-travel consultations, treatment for travel-related medical conditions, and even coordination of emergency medical care and evacuations through the resources of the Towson-based Medex Assistance.

The Center also provides medical evaluation and certification for scuba diving and medical preparation for the traveler for chronic disease management, tropical disease exposure, environmental hazards, traveler's diarrhea, high altitude adventure, Third world/underdeveloped countries, wilderness experience, and "economy class syndrome" (development of venal thrombosis, i.e., blood clots, typically a problem for travelers forced to sit for long periods of time during air travel).

"If you're in a wilderness setting and encounter a bear, how you deal with a grizzly will differ from a black bear," Dr. Zimring added. "It's not something you may likely encounter, but if you do, you'll be glad you're prepared."

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