Everything

A traveler, new to our clinic, called me about a month ago and asked me to call in prescriptions for her for malaria without seeing her. She had gone to the CDC web site for Thailand and so knew what she needed. She went to her primary care provider, who gave her the shots she asked for based on what she read on the web site, but he wouldn’t prescribe the malaria pills.

I asked her what she got for this 2 week trip and he gave her hepatitis A and B, a tetanus booster (don’t know what kind), rabies shots and Ixiaro, to prevent Japanese encephalitis. “Did he give you a flu shot? “ I asked. “No.” Then I asked where she was staying and what she was planning to do for activities there.

She asked , “What has that got to do with anything?”

And I said, “Everything .”

A backpacker planning on visiting a refugee camp on the Thailand – Cambodian border has very different needs than the company executive staying at a high end hotel in Bangkok whose needs are entirely different than the couple on their honeymoon at the beaches. The CDC web site is a great reference but it consists of one size fits all information not tailored to individuals.

She was planning a trip with a tour group and visiting the traditional tourist sites. She didn’t need the Ixiaro or the rabies vaccines, which cost her almost $1,000. She’s not sure her insurance company will pay for that, either. She did need a flu shot for that long plane ride during peak flu season, cost $25. So I gave her an appointment where we also discussed jet lag, dengue fever and traveler’s diarrhea prevention, gave her the flu shot and a prescription for malaria and azithromycin for $125.

She’s planning a trip to see her daughter in Peru next summer. She’s planning on coming to us first, for that trip.

Norovirus

It’s in our community now, it’s on cruise ships and it’s in the news. Norovirus is its real name although many people call it the “stomach flu”. And it’s no fun.

It’s well known for its sudden onset of symptoms- vomiting, diarrhea and stomach pain mostly and sometimes fever, chills, and muscle aches. It spreads quickly, especially in crowded enclosed places, schools, cruise ships, and hotels. Some people shed the virus before the onset of symptoms but most at the onset of symptoms and for up to 3 days after. It’s spread by contact with contaminated food, beverages, and by touching contaminated surfaces such as elevator buttons, door knobs, etc.

It hits fast and fortunately doesn’t last long. There is no vaccine or specific treatment. Antibiotics don’t work because it is a virus not a bacteria. The very young, elderly and people with other health issues are more suspect able to complications.

To prevent it, wash your hands! Keep your hands and fingers out of your mouth. If you are traveling take Oral Rehydration Solution packets with you to help you stay hydrated if you get ill.

Now What?

“I just booked a trip to(a great destination outside the USA - fill in the blank)and I
don't want to get sick or injured. There is so much information out there. I don’t want to be paranoid or foolish and I don’t want to spend a fortune. What do I do?”

Research a little first. Get some information about your destination and think about some of the activities you might do there. The CDC web site is compact, user friendly, complete and current. Start a folder either paper or electronic and keep your information all together. Get a current copy of all your immunizations.

Visit a travel clinic before you see your PCP. Travel health is a lot more than just shots. You may need some immunizations and sometimes they must be given in a certain order to be effective. At Travel Health of NH, we review the required, recommended and routine vaccinations and make a plan- which ones you actually need, a schedule to receive them and the least expensive way to do this. You will also get prescriptions for malaria prevention and self treatment of many common travel related health problems individualized for you and your trip.

Get travel health insurance. At least emergency evacuation insurance. Most US health plans don’t cover travel related health expenses at all or very poorly. To compare options go to www.insuremytrip.com. What might seem like a simple problem here, isn’t in many other countries. Accidents and injuries are the leading cause of serious health problems for travelers.

Pack a basic first aid kit. Consider water purification system (SteriPen), sea sickness acupressure bands, analgesics, antacids, think about common products you use that may be nonexistent where you are going.

Make a list of important numbers. Make a file and scan a copy of your passport, include emergency travel health information, past medical history and med list, immunization record, international phone number to report loss or theft of a credit card and email it to yourself. You can access email almost anywhere in the world. There are programs like mail2web.com to retrieve email if you don’t use a major account such as Gmail or yahoo.

Plan ahead, prepare and you’ll have a lot less to worry about when you travel.

How about the water?

Unsafe food and water make more people sick than anything else when they travel. Traveler's diarrhea,which can also include vomiting, fever and dehydration, can ruin a trip quickly. The most common question I get in the travel clinic is, “Can I drink the water there?”

CanIdrinkthewater.org is a web site (which is also available as an iPhone app) that quickly answers that question no matter where you are traveling.

If you can’t drink the tap water, plan ahead to protect yourself. Stay hydrated with bottled water. Make your own ice cubes with bottled water. If you have access to a freezer you can bring a small flexible ice cube tray with you. It may make sense for you to bring a SteriPen to sterilize the water yourself. Wash produce yourself with clean water.

If you can’t drink the water in a country, it also means you can’t eat foods washed in that water. Avoid salads and fruits that cannot be peeled by you. Coffee, tea, carbonated beverages, alcoholic drinks and bottled water are safe but not ice cubes or crushed ice. So, no blender drinks with those little umbrellas. Don’t brush your teeth with the tap water. Tie a hair scrunchie around the faucet to remind yourself not to automatically drink from it or brush your teeth in it. Keep your mouth shut in the shower.

Always use common sense. If a place doesn’t look clean, no matter where it is, play it safe and go elsewhere if you can.

Otherwise remember boil it, cook it thoroughly, peel it or forget it.

Avoiding Winter Travel Woes

Here are a few suggestions to help you cope with winter travel.

Right phone numbers- Keep important phone numbers handy for use during travel. Program your cell phone or write it down and keep it on you. You will need your airline, car rental, hotel, travel insurance company, etc. If your flight is late or cancelled, you can avoid the long line at the airline desk by calling them on your cell phone to make your arrangements. If you have travel insurance, call them and they will assist you.

Fly early in the morning if you can. These flights are the least likely to get delayed or cancelled. You will have more opportunities for rebooking that day. It’s no fun sleeping overnight in an airport because you’re stuck.

Check flight status early and often. You can do this from a computer, smart phone, and tablet or at the airport. Always check the departing and arrival boards at the airport.

Fly direct. If you have a connecting flight you also need to monitor the flights and weather at that destination, too. If you do have a connecting flight and the weather looks bad there, call the airline and see if you can reroute to another connecting flight.

Remember to bring your cell phone and keep it charged. Be prepared for the worst and hope for the best for easier winter travel.

Unique Holiday Gift Ideas

Looking for unique gift ideas? I found ‘em. These neckties, boxers, scarves and more combine health, education, science, art and fashion. Infectious Awareables has something for everyone on your list. How about a dust mite tie? A polio scarf? Or Ebola boxers?

Unless you know your micro, you’d never know exactly what the abstract design is that you are wearing. Is that dental plaque bowtie or HIV?

There must be at least one person on your list that’s fascinated with science, microbiology or health care. These are not just for the fashion conscience but also for those who wish to start amazing conversations that can lead into mini micro lessons just about anywhere you go.

So don’t wait, wash your hands and go to Infectious Awareables and be the hit of the office grab this year. Won’t your boss be impressed!

Choosing a Travel Clinic

The American Travel Health Nurses Association (ATHNA) offers these guidelines for consumers to help them choose a travel clinic.


1. Look for a clinic that offers customized care. Your pre-travel visit should include an in-person assessment and focus on an individualized plan specific to your health history, destination, and potential activities.


2. Ask about counseling to reduce the non-vaccine preventable risks of travel. Pre-travel preparation is more than just immunizations. Your visit should include sufficient time to address issues such as malaria, altitude illness, dengue, jet lag, and traveler's diarrhea.


3. Ask about clinic charges and payment. Charges vary widely and many travel health costs are not reimbursed by health insurance. Costs for vaccines continue to rise. Know that some clinics work on a commission basis and providers receive a percentage of the total bill. Be aware of potential conflicts of interest.


4. Inquire about the training and experience of your provider. Quality pre-travel care is offered by many health professionals, including MDs, NPs, RNs, PAs and pharmacists. However, there are few national standards for entry into practice. While membership in a professional organization, such as ISTM, ASTMH, and ATHNA, is no guarantee, it may suggest a larger commitment to the specialty.


5. Think about finding a clinic early, even before you make final payment for your trip. While most travelers need only one visit to prepare for their journey, others may require multiple visits. Ideally, you should start 4 to 6 weeks ahead of departure. However, it is never too late to receive pre-travel care. Travelers seen just hours before a flight can still reduce important travel risks.