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Dr. Alsager's
EMPORIATRICS

Counseling handout

by Dale E. Alsager, D.O., Ph.D.,
osteopathic physician & surgeon

Emporiatrics is the science of medicine applied to travelers and travel-related illnesses. Proper planning and prevention can mean the difference between an enjoyable holiday or business trip and one fraught with illness, stress and disappointment.

Travelers Diarrhea

Most commonly caused by E. Coli bacteria, Shigella, salmonella, organisms, rotaviruses, or giardia most frequently found in contaminated water or food stuffs.

Prevention: Ingest only bottled or carbonated beverages, well-cooked foods or fruits and vegetables which you can peel or wash yourself. Water of questionable origin can be generally made safe by boiling it for 3-5 minutes or by treating it with chlorine.

Treatment: Two days of Tetracycline or Cipro usually gets it under control quickly. Imodium AD can assist in symptomatic relief.

Environmental Hazards

Insects
Carry adequate insect repellent or a lotion (not a propellant spray) containing 20 to 35% DEET.

Rabies
In some foreign countries rabies is rampant. Avoid stray wild dogs and areas bats frequent. Enquire about the presence of bats before spelunking (cave exploring). If you see bat excrements in piles on the floor of a cave, leave immediately. Bats often give a spray of urine when they are frightened from their roof. Rabies virus can be transmitted in these microdroplets.

Fresh water swimming
Can present significant hazards if water is infected with parasites and/or bacteria. Make sure areas of swimming are free of contamination and/or utilize chlorinated water.

Sunburn
Carry and use adequate sunscreen at all times – minimum 15.

Jet lag
This phenomenon of fatigue is particularly important with international travel, passing through time zones. It is normal to feel "wiped out" for 2-5 days following extensive international travel which crosses several time zones. Melatonin at 1-3 mg at bedtime can assist in reestablishing sleep/wake cycles. If extended international travel over considerable distances is contemplated, plan for a minimum of 2 days rest prior to undertaking serious or intensive business negotiations or decision-making.

Altitude illness
This can occur when non-acclimatized persons are traveling to areas above 10,000 feet above sea level. Headaches, insomnia, loss of appetite, shortness of breath or fatigue are common symptoms. Mountain climbing excursions for unacclimatized persons can be very risky.

Acetazolamide 250 mg 2-3 times daily for 24 hours before or during ascent decreases the frequency of altitude sickness by 30-50 percent. This is contraindicated in patients with Sulfa allergy.

At higher elevations, two serious complications of altitude symptoms may occur: high altitude pulmonary edema (HAPE) and high altitude cerebral edema CHACE). Symptoms include labored breathing, poor coordination, weakness, coughing and confusion. The effect on judgement can lead to serious risk and possibly death. Prevention is important.

Nausea relating to travel
Compazine 10 mg tablets are useful to counteract and obtain temporary relief. It is also available in a suppository (rectal) if you are too ill to keep the medication in the stomach. Compazine should be carried on your person in anticipation of motion sickness.

Pacemakers and metal detectors
Patients with pacemakers need to use caution with metal detectors, however most appear to be safe. Check with your cardiologist ahead of time.

Preventing blood clots
Patients on anti-coagulants or who are prone to phlebitis should take special precautions - shift in your seat several times each hour, take frequent walks up and down the aisles, periodically tighten and release your abdomen and gluteal muscles, take your shoes off, slightly elevate your legs if possible. Periodically raise, lower and massage your legs, during the trip.

Judicious use of alcohol and caffeine while traveling
Note that both alcohol and caffeine tend to cause dehydration which can lead to other discomforts such as fatigue, headaches and nausea.

Immunizations
Immunizations are extremely important if overseas travel is contemplated. See Dr. Alsager for a detailed list of requirements. Dr. Alsager's office can contact the Center for Diseases Control to obtain up-to-date information. Your travel agent should also provide you with information relating to Visa immunization requirements prior to the purchase of tickets. However, agents sometimes do not have current information on immunizations, so it is the traveler's responsibility to make sure that all travel-related immunization requirements are met. It is very disconcerting to arrive at a Port of Entry of a foreign country with your ticket paid in full to find that the immigration official is prepared to turn you away because you do not have the required immunizations for that country. Immunizations commonly necessary, which need to be renewed or updated prior to travel, include tetanus/diphtheria, polio, measles/mumps/rubella, hepatitis B, hepatitis C, flu, pneumonia, malaria, Japanese encephalitis, Cholera, rabies, small pox, typhoid, tuberculosis, yellow fever, meningitis. See Dr. Alsager for details for international travel.

Motion sickness
Dramamine may suffice if you desire to sleep after taking the medication as it causes significant drowsiness. If you intend to stay awake, the Scopolamine patch, worn behind the ear, is recommended. Unless you are a seasoned sailor, use the Scopolamine patch prophylactically prior to boarding a sea­going vessel.

AIDS and other sexually transmitted diseases
These infections are rampant in many countries around the world. All travelers must be aware of the risks of these life-threatening preventable illnesses. Carry condoms with you if there is even a remote possibility that unplanned sexual activity may be encountered. Note that in some countries such as Africa, AIDS has been contracted by US travelers simply by visits to Emergency Rooms or obtaining injections for pain or immunizations in hospitals or clinics where sterile conditions are less than ideal.

Personal safety
Visits to tourist areas represent increased risk for personal robbery and assault. Remember that many desperate people congregate in these areas looking for easy victims. Use common sense. Do not go out at night alone in unfamiliar areas. Walk or travel with a friend or companion whom you know. Look around before entering or exiting vehicles, do not carry purses or items of obvious value, such as jewelry, watches, necklaces, etc. in plain view.

Travel Insurance
Recommended and can be obtained on a trip by trip basis for possessions, medical insurance and/or loss of life, usually at reasonable cost.

High Risk Activities

Scuba diving, para sailing, cycling, hang gliding, sailing and bungee jumping are all enticing holiday activities which require skill, training, reliable equipment and a safe environment. If you do not see obvious signs of safety procedures, training certification, business license, or safety equipment, decline the ride. Avoid unsupervised beaches and ask locals about salt water hazards such as rip-tides, jelly fish, red tide and sea weed beds before participating in water related activities.

Dr. Alsager's Travel Emergency Medical Kit

Emporiatrics is the science of travel medicine. In today's world of high mobility, people are traveling more frequently over greater distances and often outside the continental United States. During travel, patients are at risk for numerous illnesses and ailments. Illness can be very uncomfortable and hazardous to your health if you are in a situation without availability of good medical care. As a patient of Dr. Alsager's clinic you are advised to carry the attached kit while traveling, in order that your continuity of care is not compromised. We want you to enjoy your holiday or business trip to its maximum potential.

Travel kit contents (excluding any medication intolerances/reactions):

1. A pain killer. Tylenol Extra Strength (ibuprofen 200 to 800mg may be used to substitute).
2. Antibiotic ointment. Neosporin or Triple Antibiotic for minor cuts or abrasions. A "Z"-Pak as a contingency supply of antibiotics for bacteria infections is recommended.
3. Bandages, sterile gauze pads, bandaids, blister pads or covers.
4. Small oral thermometer.
5. Insect repellant (should contain the active ingredient DEET in strength from 20 to 35%).
6. Sunscreen, strength over 15.
7. Diarrhea relief. Pepto Bismol, Imodium. If bacterial cause is suspected, Tetracycline 100 mg 2 per day (adults only) times 2 days. Alternative: Cipro 2 per day times 2 days.
8. Anti-fungal skin cream. Ketoconazole 2%, prescription.
9. Cough suppressant, 2-4 throat lozenges, small quantity of Tessalon pearls.
10. Decongestant and antihistamine for colds or allergies (Entex LA, Claritin D, Zyrtec or Oxymetazoline hydrochloride are recommended in small portable quantities.
11. For known severe allergies to bee stings, patients will need to carry Benadryl and Epinephrine syringe as a bee sting prophylactic kit. See Dr. Alsager for details.
12. Hydrocortisone cream for skin irritations or insect bites.
13. Pair of tweezers (to extract slivers or ticks).
14. Eye drops such as HypoTears to flush foreign bodies from eyes.
15. Small quantity of pre-moistened towelettes.
16. Water purification tablets, bottled water or water filter.
17. Motion sickness medication (Dramamine will suffice but causes severe drowsiness). If you intend to stay awake then use Transdermal Scop (Scopolamine used as a little patch applied behind the ear).
18. Extra glasses or contact lenses.
19. Dr. Alsager's personal letter authorizing travel and the carrying of prescription medications noted in the above list. The letter should be contained in your travel medicine kit and readily available for presentation to border crossing or customs inspectors.
20. Carry adequate prescription medications to cover unexpected delays in return home. Also carry copies of all prescriptions with the generic name of the drug and a letter of authorization listing your regular prescription drugs for inspection by customs or border crossing officials.
21. Carry your travel-related medications and items in a compact enclosed bag containing nothing else and take precautions against accidental loss or theft of these important items.

Bon Voyage!

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