Travel Medicine 

With summer approaching, many of you are or will be planning family vacations or other trips. When you hear the words “travel medicine” you probably think of taking a trip to a far away exotic port or going to the remote jungles of South America.  In reality, travel medicine includes all the planning you should do to protect your health on ANY trip.  An overnight trip to Seattle may require a lot less medical planning than a trip to the Honduras, but all of these trips should involve some planning for your medical needs, especially if you are on daily medication or have a chronic medical condition.

Let’s start with the mundane preparations for an overnight or short trip:

The first consideration is your daily medicines.  You should carry enough medication to last you at least one week longer than your trip – in case of flight delays, etc.  You should pack your medications in your carry-on baggage, just in case your luggage gets lost.  This is especially true if you are on any type of medication where missing one dose could impair your health (high blood pressure, diabetes, etc.)

The second consideration is medical needs that might arise on trips.  First and foremost are the abdominal disturbances from travel.  Your diet will be different than it is at home and you may become constipated.  You may want to keep some type of fiber supplement and perhaps some Colace (docusate sodium) just in case.  The other end of the spectrum is also possible and is more urgent when it happens.  Diarrhea can occur due to differences in bacteria in the local drinking water, dietary changes, sleep loss, or other causes.  Treatment for routine traveler’s diarrhea includes Pepto-Bismol or Imodium.  Fiber supplementation may also be helpful, but may worsen symptoms, so try this cautiously.  You may want to keep all of these medications in your overnight bag.  If you have bloody diarrhea or fevers, you may have a more serious infection and should seek medical attention.  If you have asthma I strongly recommend that you take your medications with you.  Even if you are only on a rescue inhaler such as Albuterol, you should carry it with you just in case you have a flare of your asthma while away from home.  If you tend to have allergies you may want to pack medication you use for that depending on what time of the year and where you are going.

Now let’s take a look at the more exotic aspects of travel medicine:

Lets say you are taking a trip to Ecuador.  You should start planning months ahead, just like applying for your passport – allow time for unexpected delays.  (By the way, if you don’t have a passport you might want to start that application process soon as well!)  A good start is to visit the Center For Disease Control’s web site www.cdc.gov.  There is a tab called “Traveler’s Health”, which will take you to a table of contents, and there you can click on “Destinations” which will take you to a world map. From there you can click on the location you are planning to travel to.  This site will discuss vaccinations and malaria prophylaxis if needed.  This site also discusses other travel related health issues. It is important to check this website rather than printed information since travel vaccine recommendations change frequently and the web site has the most up to date information.  For example, there are a few different medications that can be used for malaria prevention.  It depends on where you are going to and (in some areas) the time of year you will be there which type of medication will be recommended.  You should visit your health care provider ideally at least two to three months before your trip.  Some of the vaccines recommended are actually a series of shots, but you can get some immunity from the first injection.  For example, if you are traveling to developing countries, Hepatitis A and Hepatitis B vaccines are frequently recommended.  These are both a series of injections over six months.  You should also be up to date on Tetanus.  If you are staying in tourist areas where the facilities will be clean, at tetanus booster in the last 10 years is fine.  If you are going to more remote areas, I would recommend a booster if you have not had one in the past five years.  Vaccination against Typhoid may be recommended.  There is a shot, which is good for two years, and an oral vaccine that is good for five years.  So if you plan on being a frequent visitor to remote areas, you may want to get a prescription for TY21A (vivotif) (the oral vaccine).  You may need to do some research to find a pharmacy that will fill this medication, since it will be a special order.

Traveler’s diarrhea also takes on a new twist if you are traveling to more remote areas.

Again, a simple change in diet and bacteria in the local water supply may cause this.  You will want to find out if the water is safe to drink (in most developing areas it is not), or if you will need bottled water.  Depending on whether you are going to a tourist area, or going where the “locals” hang out there may or may not be a source of clean water.  You can bring your own water treatment supplies with you if you are going deep into the jungle.  You can check on-line or at REI or GI Joe’s for this equipment if needed.  If the local drinking water is unsafe, then you should consider all raw fruits and vegetables unsafe.  The following rule is always safe:  Boil it, peel it, cook it, or forget it.  This sometimes leads to skipping the fruits and vegetables, which leads to the constipation issue and again fiber and Colace may be needed.  Also avoid buying food from the local street vendors.  This may look much like our own Saturday Farmer’s Market, but you may get more than you bargained for!  The other issue to discuss with your health care provider is whether or not you should carry antibiotics to treat the diarrhea.  Some cases are caused by bacteria that respond quickly to “quinolone” antibiotics, and may respond to a singe dose.  You will want to discuss with your health care provider if taking this medication would be safe and recommended depending on your specific health status. There are other rare infections that you may be at risk for if you are going to remote areas, especially if you will be near rivers or other fresh water.  It is safest to avoid wading or swimming in fresh water.  Salt water is generally safe to bath or wade in, but these are issues that you will want to explore with a health care provider familiar with tropical diseases or review the information available at the CDC’s web site listed above.

You should also keep in mind the recommendations in the paragraph regarding an overnight trip.  It is even more crucial to pack your medications (and eye glasses or other personal items) in your carry on luggage since you may not be able to get to a pharmacy to get replacement medications if yours is lost with your luggage.

You also want to consider what the climate is going to be like where you are going.

If you are traveling to the tropics (Hawaii, etc.) and you are leaving Vancouver in the winter, you might not remember things like sunglasses and sunscreen, but these will be needed.  If you are traveling somewhere that may be much colder than the local weather you want to be prepared with hat, gloves, and warm clothes.  Are your traveling to somewhere like Denver or the mountains of South America where altitude may be an issue?  If so you should increase your aerobic exercise in preparation for your trip and you should discuss medications to prevent altitude sickness with your health care provider. Altitude sickness usually does not occur until heights of 8,000 feet, but may occur at lower altitudes depending on your overall health.

I hope this information has helped you to be more prepared for any trip you may be planning.  If you are planning on a trip, I wish you Bon Voyage, Um ason piw a'ni, Ciao, Salaam, Adios, Auf Wiedersehen, Tschüß, Arrivederci, Do svidanja, or as the say in Ecuador Wea jai!

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