Clean Water in the Palm of Your Hand

Finding an adequate supply of clean water is a challenge in many places people travel. Drinking only clean water is your best defense against contracting many diseases, especially traveler’s diarrhea. Bringing your own water isn’t always feasible and many products to purify water left behind chemical tastes and took a lot of time to process.

But now there is a product that works in minutes and fits in the palm of your hand. The SteriPen sterilizes a 16-oz. cup of water in less than a minute with ultraviolet light that eliminates over 99.9% of viruses, bacteria and protozoa that cause waterborne illness. It doesn't need to be plugged in and it’s portable, packable and powered by AA batteries.

You can use it for international travel or camping in the USA. This past week, a group of relief workers heading to Haiti, purchased SteriPens from us to help prevent cholera.

Looking for a holiday gift for that hard to please traveler? Check out SteriPen.

The Question I Hear Most Often Is

Why should I go to a travel clinic before a trip?

Here are the top 10, some of which might surprise you.

1. We do all the internet leg work for you. We consult with experts in the US and Switzerland daily to stay on top of the latest outbreaks, safety concerns and vaccine recommendations and requirements.

2. You may not be fully protected against illnesses present in other countries, such as polio and typhoid. We can discuss routine, recommended and required vaccines.

3. You’ll get a prescription for the medication that is best suited for you (side effects, cost, and convenience) to prevent malaria, a potentially life-threatening disease that is present in many tropical countries.

4. We’ll tell you how to prevent and treat traveler’s diarrhea, a condition that can ruin your trip and stay with you for weeks after you return.

5. We’ll tell you whether you will have any problems with your regular medications or treatments while traveling. Are any of your prescriptions controlled substances?Are you a diabetic carrying syringes? Use medications that need refrigeration? Use a C-Pap machine?

6. There are many diseases for which there are no vaccines, such as dengue fever, which you may not have ever even heard of before. We’ll tell you how to prevent it.

7. We’ll teach you about food and water precautions.

8. We’ll give you tips and treatments for jet lag.

9. You’ll receive a wealth of suggestions for staying safe, including accident prevention tips, embassy contact information, overseas health and emergency evacuation insurance and local health care resources.

10. We carry specialty products to keep you healthy and safe- dental emergency kits, first aid kits designed for your destination, syringe and suture kits, oral rehydration solutions, insect control products, and much more.

Time to Talk about Flu Vaccines

There are new recommendations about flu vaccination this year. The biggest change is that flu vaccines are now recommended six months of age or older (in the absence of medical contraindication). There is no preference given to the intranasal or the injection form, for healthy, non-pregnant persons age 2-49 .Children from 6 months to 8 years of age will again require two doses of influenza vaccine, unless they received at least 1 dose of H1N1 vaccine during the 2009-2010 season and two doses of seasonal influenza vaccine (either both last year or in two different years).

The 2010-2011 seasonal influenza vaccine is already available. We received our shipment 2 weeks ago. It contains three strains – the 2009H1N1 antigen is the same as the H1N1 vaccine from last year, the H3N2 is a new antigen and the influenza B strain was in last year’s seasonal vaccine. Persons with a history of influenza or vaccination last year should be encouraged to get the vaccine again this year, due to the natural waning of the antibody response and the added protection of the new antigen in this year’s vaccine. It is not too early to begin vaccinating now, since we do not know if the season will peak early, as it did last year (at the end of October).

There is also a newly approved high-dose influenza vaccine for persons 65 years of age (Fluzone High-Dose). It is an alternate inactivated vaccine and it contains four times as much hemagglutinin antigen as the standard dose vaccine and is more costly. Neither CDC nor ACIP is expressing a preference of one vaccine over another for this age group at this time.

Call us today at 603-528-4304 for your flu shot.

Get Your Feet Wet

On January 14, 2011 Gail Rosselot, ANP, CTC, FAANP and I will be escorting a group aboard Cruise West’s “Pacific Explorer” through Panama and Costa Rica. This 9-day 10-night cruise begins in Panama, transits through the Panama Canal and heads along the Pacific coast north toward Costa Rica’s beautiful Los Suenos Marina. We are offering a continuing education program in travel medicine for primary care providers and those in travel medicine.

Highlights of the trip include swimming, snorkeling, kayaking, hiking and visiting botanical gardens, national parks, and spending the day with an indigenous tribe only accessible by Zodiac boats.

This trip of a lifetime is open to those with a sense of adventure and although workshops will be offered to NP’s, PA’s, RN’s and MD’s. But anyone interested in exploring Central America is welcome to join the group (even if you decide not to participate in the conference) and group discounts apply to all.

I have traveled with Cruise West and I am impressed with the level of service they offer. The ship’s capacity is 100 passengers. Everyone is so friendly and the naturalists onboard are are so well informed about the local wildlife, birds, peoples and culture. The solo traveler as well as the one who brings friends or family will all feel welcome.

Unpack once and be prepared to be awed by the beauty that is all around you. The rates include everything except alcohol, and tips are not required or expected. It is such a relaxing way to travel.

This is not a typical cruise ship. Getting dressed up for dinner means putting shorts on over your bathing suit. Space is limited so sign up today.

For full information visit www.unique-workshops.com.

Fun in the Sun

A sunburn can not only increase your risk of skin cancer but put a big damper on your vacation.

Here’s your best defense against too much harmful UV radiation.

Prevent sunburns by covering up. Shirts, hats, shorts, and light weight pants shield your skin. Many companies make clothes with higher UV protection than regular clothing, too. Stay in the shade. Sit under a tree, use a beach umbrella or even take a beach tent or canopy with you , if possible. Some beaches rent umbrellas or covers for very reasonable rates. Avoid midday sun. Plan activities early morning or later in the afternoon. Don’t forget to protect your eyes with sunglasses and a visor.

Now use your sunscreen. Some sunscreens prevent sunburn but not other types of skin damage. Look for a product with broad spectrum coverage. Pick an SPF based on your skin type, the time you will be outdoors, what types of activity you’ll be doing and of course, the weather. Don’t be fooled into thinking you don’t need sunscreen on a cloudy day. Many woman use sunscreen regularly to protect from cosmetic skin damage. Everyone knows to use sunscreen on kids. But studies show men don’t use sunscreen often enough.

Thumbs Up Tenderfeet

Last week I returned from a safari to Kenya with Prestige Plus , a travel club of Laconia Savings Bank. Twenty seven of us rode Land Rovers through miles and miles of some of the most beautiful landscapes, sunrises, and game reserves on this planet. The expanse of the parks and numbers of the animals made me feel quite insignificant. That is until our last day, when we were to visit an orphanage in Nairobi. Like LSB, Collette Vacations is a strong supporter of the communities it does business with and assists local efforts to improve the lives of those who need some help. It brings its travelers here to see a part of Kenya not usually visited by tourists. We brought donations and were asked to help open the new building of the Tenderfeet Education Center. On the way, we stopped at a local grocery store and bought school supplies to bring with us. Another way we got to see Nairobi up close.

We drove through a slum of 60,000 people to this small cement building that educates and feeds and gives hope and love to 80 orphans from AIDS ages 2-10. After Valerie Drouin, VP and Rodney Dyer, Chairman of the Board of Laconia Savings Bank, cut the ribbon the children sang a song about Kenya. In the chorus they sang Valerie has a friend in Kenya, and Rodney has a friend in Kenya and the visitors all had a friend in Kenya. They were so happy to have us and so very grateful for our support. And invited us to please come back.

There are many plaques throughout NH thanking Laconia Savings Bank for its help. But the one in Nairobi is quite special.

I did feel that the money I spent on safari helped the local economies. But what I left there made a far greater impact, perhaps on me more than them.

Safari to Kenya Day 1

Between watching the winds that determine volcano ash direction and the politics of a strike, getting to Nairobi, via London, has been a challenge. After a long flight, it felt great to stretch my legs as I walked through Heathrow. As with any large international airport once you exit the plane you have quite a distance to go to exit the airport. As I walked down long corridors, up and down stairs, took a train and weaved through the cues, I wondered how far I'd walked. I sat beside an older woman on the bus to our hotel and she estimated we'd probably walked one mile, perhaps more. She doesn't travel often and was very surprised that we had to walk so far in the airport. I was thinking it wasn't nearly as long as other airports I'd been to.

I didn't ask my seat companion her age. But it got me thinking. How realistic are the expectations of some older, less experienced travelers about the physical aspects of their trips ?Those of us in travel health need to be more aware of how fit our clients for their travel. Originally we had a connecting flight with a two hour layover. Not much time to traverse a large airport especially for slower goers.

After an entertaining meal at a local pub (fish and chips, of course) we leave London for an early flight to Nairobi.

No Ice, Please

Food and water precautions are a frequent topic of conversation in travel clinics. There are so many places in the world where you simply can’t drink the water. And that means no ice, either. So what do you do when you forget to tell someone no ice and you are brought a drink with ice in it? You call the waiter over and ask for one with no ice. He walks away and returns with a glass with your beverage and no ice. But what happened?

Did the waiter remove the ice with his hands? Once the ice was removed, did fill the glass with more of the drink? Maybe, he poured out the drink and filled the same glass with a new drink. Or, maybe he got a new glass with a fresh drink. Problem is, you don’t know. So, what do you do?

If I get a drink with ice, I send it back and say I changed my mind and order a beverage that is carbonated in the bottle or order something that has been boiled, such as hot tea or coffee. You could ask for a bottle of water and ask to open the bottle yourself but you can’t be sure that it has been processed with sanitary water under sanitary conditions or hasn’t been tampered with.

The alcohol in alcoholic beverages will not kill bacteria lurking in ice cubes. But, you could order beer or wine.

A Tale of Two Students

This is the true story of Jane and Kathy, who are roommates going to Nicaragua for a semester abroad. They were advised to go to a travel clinic prior to departure. Jane is trying to save money and since most travel clinics don't accept insurance she went to her primary care provider. Kathy came to our travel clinic and got a statement to send in to her insurer for possible reimbursement direct to her.

Jane received a hepatitis A vaccine (cost $95 plus $30 to administer the vaccine) and got prescriptions which she filled at her pharmacy for Lariam for malaria ($204) and oral typhoid vaccine ($65). She paid her $25 copay for the visit and was told they would submit it to her insurance.

Kathy got a hepatitis A vaccine ($85 and we don't add an administration fee) and oral typhoid vaccine($66) that was packaged in a small Styrofoam cup with ice and a lid to keep it cold until she got home. She filled a prescription for choroquine for malaria ($85) at her pharmacy.

Jane said nobody told her to refrigerate her typhoid vaccine which she had left out. She looked at the small box and there was a sticker that said refrigerate it but she didn't see it. She called the pharmacy who said the vaccine was no good and they couldn't take it back or replace it. She would have to call her PCP for a new prescription and have to pay for it again.

She asked Kathy why she had a different malaria prescription. Kathy said she was told this one was less expensive and safer for someone with a history of depression. Jane is taking an antidepressant that she gets filled through her mail order pharmacy. She called the pharmacy again and asked about Lariam and depression and was told said she shouldn't take the Lariam and to call her PCP. Lariam was not returnable or refundable.

She called her PCP who agreed that Lariam might cause problems for her and that she could have a prescription for choroquine. Her PCP doesn't usually write prescriptions for malaria prevention.

Jane was not happy. She was out $270. Then she got a statement from her insurer saying that her travel visit and hepatitis A with her PCP was not covered due to her deductable and she owed them $250 less her copay. Her total cost now is up to $605.

Kathy however spent $283 for her visit and $85 for her prescription for a total of $368. Going to a travel clinic first? Less expensive, less aggravating and you get the benefit of expert travel advice.


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Get It Together Before You Go

Perhaps the most stressful part about traveling is getting everything ready before you go. Keep a checklist in a document file that you can refer to before each trip so that you will worry less about forgetting something essential.

Use a document neck holder in the airport or train stations, so that you can have both hands free but keep your travel documents safe and readily accessible at all times. Choose a wallet just for travel that is small enough to carry only essential items. Think about preventing pick pockets and keep your wallet in your front pants pocket, around your neck or in a purse slung across your shoulder.

What I need to bring

Tickets- air, bus, and/or train
Passport and any travel visas
Travel /health insurance information
Copies of my passport, Visas, and extra passport photo kept separate from originals
Driver’s license (even if you aren’t planning on driving – it’s a back up photo ID)
Copy of itinerary, address, phone number for inside your luggage tags
Send yourself an email with your itinerary, medical history/medication list, passport number, and emergency customer service numbers for your credit card company
Confirmation documents for hotel, activities, etc.
Photocopy of any essential prescription drugs you take
Copy of your eyeglass prescription

Take only the essential items from your regular wallet. Take only the credit card(s) or ATM card that you will need for this trip. Leave everything else at home.

Once you make this list, it will be a time saving tool you will use over and over again.

Costa Rica - A Snap Shot

Are you looking for a great vacation in an exotic locale with stunning natural beauty, miles of pristine beaches, wildlife, snorkeling, kayaking, nature walks and even zip lining through a tree top canopy? Check out Costa Rica.

We arrived in San Jose and spent 2 days in Monteverde in the cloud canopy. Walking on the suspension bridges through the rain forest made you feel small in the lush greenery but one with it all. The smells of moist ferns, the sound of howler monkeys in the distance and the touch of rain- vertically and horizontally were exhilarating.

Then we boarded the Pacific Explorer in Los Suenos and spent the next 10 days cruising the Pacific coast, visiting national parks, deserted islands, botanical gardens and transited through the Panama Canal under the guidance of four highly educated naturalists. We swam, snorkeled, hiked, and took photography walks with Dennis Finn, a professional photographer, who helped us see this beautiful place through light, color and composition. My point and shoot camera never pointed and shot so well!
Costa Rica is clean and the food fresh and healthy. We had our hepatitis A shots and prescriptions for ciprofloxin to be prepared for traveler’s diarrhea. We used 30 % DEET to prevent mosquito bites but didn’t need malaria prophylaxis. We actually saw very few mosquitoes and bugs in general. I did get a bite in the water that might have been a small jelly fish and used After Bite Extra right away and it worked instantly. Most everywhere we went people spoke or understood English or my limited Spanish.
So consider Costa Rica. Check with your local travel clinic to see what you would need as it will vary based on your exact itinerary and planned activities. Pura vida!

Top Ten Travel Tips for Every Traveler

1. Be sure you are fully immunized. Check with your primary care provider or
travel clinic 4-6 weeks before travel if possible.

2. Be familiar with food and water precautions for your destination.

3. Know where the nearest US consulate is located.

4. Pack a first aid kit specific for your itinerary.

5. Don’t go barefoot.

6. Prevent bug bites to prevent bug borne illnesses.

7. Take out trip health and emergency evacuation insurance.

8. Use the right sun protection.

9. Register with the US State Department before you go.

10. Wash your hands! Wash your hands! Wash your hands!

Fun in the Tropical Sun

When I decided to go to Panama and Costa Rica my biggest concern was how this fair-haired, green eyed , freckled traveler would survive the tropical sun. I am proud to say that with a little attention to detail- I didn’t burn.


• Choose a sunscreen with at least 30 SPF. I used 50 SPF since I was in the
sun constantly.
• Select a water- and sweat-resistant product that provides protection against both UVA and UVB rays. Apply ½ to 1 hour before exposure if possible.
• Use at least 1 oz of sunscreen for total body application (i.e., quarter of a 4-oz bottle).
• Apply to all exposed areas, especially the ears, scalp, lips, back of the neck, tops of the feet, and backs of the hands. For snorkeling, I hiked up the back of my bathing suit and used sunscreen there so that when my bathing suit rode up a little from kicking, my bottom was protected. I also remembered to apply it behind my ears.
• Use spray for hard to reach areas.
• Reapply after 1–2 hours and after sweating, swimming, or toweling (even on cloudy days).
• Many sunscreens lose potency after 1–2 years.
• Sunscreens should be applied to the skin before insect repellents.
• Avoid products that contain sunscreens and insect repellents. (DEET-containing insect repellents may decrease the effectiveness of sunscreens and may increase absorption of DEET through the skin.
• Cover up. I wore a long sleeved high SPF sun protective shirt when I snorkeled. It dried quickly and was very comfortable.
• Don’t forget a hat and sunglasses.

Keeping Track of Important Travel Information

Losing your passport, airline or hotel confirmation number can be a nightmare. Many people will make multiple copies and take those with them. But here’s a better idea - I send myself an email with all my important information.

If you get separated from your group, get lost, injured, or worse, you will likely end up in an airport, hospital, embassy, military or police station where internet access is available just about anywhere in the world. If you have a Gmail or Yahoo account, you can access your email from any computer. Don’t have a Gmail or Yahoo account? You can still send yourself an email and retrieve it at www.mail2web.com. It’s free. Type in your email address and password and there is your email.

I send myself my passport, itinerary, the international telephone number for my credit card company customer service line, immunization records, important medical records and medication lists, hotel confirmation numbers and telephone numbers, and anything else you might think helpful. Keeping track of important travel information easily gives you peace of mind.

Thinking about going to Haiti?

The disaster in Haiti has left all of us wondering what we can do to help. Many of us have donated money and some are going to help. If you are considering going to Haiti to volunteer, here are some things you need to know.

The CDC has developed guidelines for relief workers and others traveling to Haiti. Check this site frequently for updates.

Before you depart you must have all your routine vaccinations current - tetanus and diphtheria, measles/mumps/rubella (MMR), polio, seasonal and H1N1 flu and chickenpox (varicella). You will also need hepatitis A and B and typhoid.
If your departure is eminent, accelerated schedules of hepatitis A and B can be given. Even one dose will afford some protection.

You must take measures to prevent insect borne diseases, such as malaria and dengue fever. This includes taking prescription medications and using insect repellent with DEET.

Haiti has a high prevalence of HIV infection. To reduce the risk, always wear gloves when coming in contact with blood or any body fluids or touching any surfaces soiled with such. Find out from your group if you need to bring your own gloves.

Tuberculosis rates in Haiti are very high. A tuberculin skin test is recommended before you go and 6-8 weeks after you return. If you will be having direct contact with TB patients, wear an N-95 respirator mask.

Anthrax occurs in Haiti and is transmitted by direct contact with infected animals or with contaminated products from infected animals.

A visit to a travel health clinic is important prior to your trip for immunizations and prescriptions. If you think you are going to go, call your local travel health clinic and get prepared now.

Cozy in coach?

Are those seats getting smaller? Flying coach seems to be getting more and more uncomfortable. If you plan ahead and pack a few items on your carry-on you can improve that.

Avoid dehydration. Bring bottled water on the plane. Make sure to purchase bottled water after you’ve gone through security.

A small bottle of soothing eye drops such as artificial tears is a welcome relief. Keep lips hydrated with lip balm. I keep both in a small sandwich sized zip lock bag that I put inside my quart sized zip lock bag for security. Once I’m through security, it’s easy to pull out just what I need for on the plane.

Have back issues? Bring a self inflating seat cushion to support your back and hips. Neck issues? Bring an inflatable neck collar, so that no matter what position you’re in, your head is supported when dozing.

Many people complain of headaches while flying. Preventing dehydration helps but so will noise cancelling head phones. That constant drone of the engines is greatly reduced and you won't be subjected to someone else's conversations. A cool eye mask blocks light and reduces headaches and eye puffiness.

Think about making it easier to maneuver around in small rest rooms. Wear loose fitting clothes without belts. Shoes that are easy to get on and off and allow for a little swelling are also a wise choice.

With a little forethought, riding coach can be a little less uncomfortable.

Personal first aid kits for traveling

What you need to bring for a personal first aid kit will depend on your health, where you are going and how long you will be there. Here are some suggestions of what to bring for a 2-3 week trip to a tropical area in an under developed country. Remember to bring small amounts in small tight containers that are well labeled.

Band aids made of cloth not plastic (they can melt)
Alcohol preps- those foil packets of alcohol pads about 10
Sunscreen - waterproof  SPF15 higher
Lip balm with SPF 15 or higher
Soothing eye drops or artificial tears
Tweezers and small scissors ( put in check on bag not carry on)
Duct tape - take a toilet paper cardboard tube and cut in half and wrap a few yards of duct tape around it to make a small roll
Small tube of triple antibiotic cream (ointments can melt)
Bug bite cream - 1% hydrocortisone cream, diphenhydramine cream or a product such as After Bite
Prescription medicines in original labeled bottles
Anti diarrhea medicine - available over the counter
Acupressure wrist bands for motion sickness
Mild laxative tablets
Aspirin or ibuprofen or acetaminophen (depending on what you can take based on allergies, health problems and concurrent medications - if in doubt ask a health professional)
Emergency dental kit

If you wear contact lenses you may want to leave them home. Lack of clean water makes proper handling and cleaning contacts a problem. The dryness of the airplane and dust on safari make wearing contacts uncomfortable.

There are first aid kits available that have most of the above all prepackaged. If you don't use it on this trip, there is always the next!

Packing for a Safari

Packing for a safari is different than packing for other types of trips. Pack light! Be able to get everything in a duffel bag or soft sided suitcase. Find out if you have a weight restriction and abide by it. Pack your essentials such as your camera, prescriptions, money, travel documents, yellow certificate of vaccination and passport in your carry-on bag. Leave your jewelry at home. If you couldn’t bear to lose it – don’t bring it. Flashy jewelry and clothes, especially red, are not appreciated by the wildlife!

Suggestions for packing

A pair of comfortable walking shoes that are broken in
A pair of closed toe sport type sandals
Underwear, socks, pj’s
Bathing suit for pools at the lodge
2 long sleeved shirts ( light colors are best)
2 short sleeved shirts
1 pair of shorts
2 pairs of long pants (consider the type that zip off into shorts)
Wide brimmed hat and 2-3 cotton bandanas
Lightweight fleece pullover
Toiletries – consider body wash that can be used as cleanser and shampoo in
one, hand sanitizer, travel size tooth brush and paste, etc. (think small and
water proof containers)
Face cloth
Day pack for carrying camera and supplies, binoculars (7 X 28 or 8X 21),
sunscreen, lip balm, hand sanitizer, etc.
Sunglasses
Insect repellent with 30 % DEET or more
Zip lock bags in various sizes
Travel alarm clock
Small flashlight


Plan on wearing everything 3 times. Most camps have laundry service. Remember, it’s not a fashion trip, be comfortable and dress to protect yourself from the sun and bug bites.