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Sep-03

Travel Medicine - Part II
seat of a car) and limiting head movements are are risk factors. Good physical conditioning is headache, irritability, insomnia, fatigue, nausea, vomiting, muscle aches, and edema.
meclizine, and dimenhydrinate, which can be Several specific syndromes exist, with cerebral gotten without a prescription; all have the and pulmonary edema representing the most potential to produce drowsiness (not a bad thing under most circumstances). Scopolamine alcohol and sleeping pills or tranquilizers, and RADM Peter L. Andrus, MC, USNR
patches are available by prescription, but disease likelihood and severity increases at National VP for Health Programs
altitudes of 7,000 feet and higher. Slow ascent, the elderly, or those with certain medical good hydration, a high carbohydrate diet, and In the first installment of this two-part article conditions. You should check with your doctor acetazolamide (Diamox) taken in advance are on travel medicine, we reviewed necessary protective. In the event of symptom onset, immunizations, health records, and a travel Montezuma and Other Woes
reducing altitude or slowing rate of ascent is first aid kit. This month, we will review some essential; it may be life saving in the face of specific travel-related health problems and the ailment affecting international travelers of all severe pulmonary or cerebral symptoms, which sorts and is characterized by any or all of the would also require treatment with oxygen and Getting There
following symptoms: multiple loose or watery steroids. Other symptomatic measures would With jet travel through multiple time zones stools, abdominal pain and cramps, nausea, include simple pain medications for headache characterizing leisure, business, and military vomiting, and blood in the stools. About one travel, the jet lag syndrome is well recognized quarter short term travelers will experience Compazine). The traveler should consult with by all and has been experienced by most of us.
traveler’s diarrhea, while approximately three his/her physician for further guidance.
Primary symptoms include fatigue, diminished quarters of longer term sojourners will be concentration, daytime drowsiness, insomnia, afflicted. A wide variety of “bugs” can produce when in travel status to that while at home.
and alterations in gastrointestinal functions. All the syndrome. Bacterial causes (e.g., E.coli, They cause most of the accidental deaths that result from the interruption of sleep-wake Shigella, and Salmonella), parasites (e.g.
occur during travel. Current experience of our cycles and circadian rhythm and will impact Giardia), and viruses (e.g., rotavirus) all forces in Iraq confirms this emphatically.
effective functioning for about one day for each contribute to the burden of disease. Attack Motor vehicle accident rates abroad are much time zone crossed in transit. A good night’s rates are lowest in North America, Europe, higher than those in the United States, and sleep prior to departure is essential. Since air Australia, and Japan and much higher in the trauma centers are generally nonexistent in travel tends to dehydrate, good fluid intake and Middle East, Asia, Africa, and Latin America.
the event of injury. Lack of seat belts, poor Avoidance of uncooked fruits and vegetables essential. Setting watches to the destination and local water sources are essential for passenger areas of vehicles, and poor road time zone and relaxation materials (books, prevention. Taking preventive antibiotics is conditions all contribute as well. Safety music) are helpful. If a long distance flight is in usually inadvisable, due to the risk of allergic measures include use of native drivers or public the offing, use of earplugs and eyeshades to reactions or side effects. In the event that train or bus transportation where available, support sleep while en route can be useful.
insistence on seat belts and properly working hydration (fluid replacement) is essential.
safety equipment in rental vehicles, avoidance Promethazine (Phenergan) suppositories will of night driving, and absolute avoidance of followed scrupulously for best effect.
aid against nausea and vomiting; loperamide driving under the influence of alcohol or drugs.
(Imodium) will reduce frequency and improve Infectious disease entities of concern vary by malaise, which is brought on by disruption of consistency of stools. If symptoms persist, an travel destination. Detailed discussions of these the normal relationship between inner ear and oral antibiotic such as a sulfonamide (e.g., are beyond the scope of this article, but a few Septra) or a quinolone (e.g., Cipro) may be comments are in order. Malaria represents the started. Peptobismol has also proven effective – single most important infectious disease entity discomfort, sweating, dizziness, and vomiting.
tablets are lighter to transport than liquid. The for travelers on a worldwide basis in terms of Preventive and palliative measures include risk of mortality. Protective measures are avoiding travel on an empty or overly full medications to carry for these problems with effective and essential; failure to exercise stomach, visual fixation on a distant horizon, appropriate precautions can be critical, as adequate ventilation, and avoiding visual Acute mountain sickness (altitude illness) is witnessed by the recent experience of the stimuli (reading or watching a movie). In addition, seeking a central position in one’s holidays and those deployed to operational including permethrin-coated clothing, use of mode of conveyance (over the wings, aisle seat commitments at altitude. Youth, rapid ascent to DEET containing insect repellant, bed netting, in a plane; in the middle of a ship or boat; front altitude, and a past history of mountain sickness and oral chemoprophylactic medicines may be Health Affairs – Cont’d. from page 22
life saving. Medical providers can offer specific recommendationsthat are pertinent to the area of travel and provide necessaryprescription medications that must be started in advance of travel,continued while in travel status, and upon return. Specific detailsof side effects of each medicine and the exact dosing schedule varywith the medication chosen. Sexually transmitted diseases,including most notably HIV, are a considerable risk in many areasof international travel. Prudence would dictate abstinenceor appropriate protective measures. Other emerging infectiousdisease threats, such as severe acute respiratory syndrome (SARS),are of concern to travelers. Your primary physician or other healthcare provider should be able to provide updates. Pretravel healthadvice, travel alerts and health advisories can also be obtainedfrom the CDCs Web site at <www.cdc.gov/travel>.
I hope this brief, two-part synopsis on travel medicine has been

Source: http://ausn.org/Portals/0/Services_pdfs/Health_Affairs-APR04.pdf

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