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Quick Travel Advice

OMG! We leave in 2 weeks! Do we need to go see the doctor?

This question is a very common question in many households. With global travel growing by 5% during the first eight months of 2014. Between January and August 2014, 781 million people traveled internationally. Planning your next trip to Mexico or Peru or India or China or perhaps South Africa, is a very exciting experience. The reason for the trip may be on a wish list, or perhaps visiting family and friends or just a trip that you have saved up for and dreamt of. Whatever the reason, the mind starts exploring all kinds of things – where should I stay? do? restaurants? night life? museums? tourists events, etc etc. Trip Advisor is a good go to place for reviews etc. You may have seen a mention of health issues mentioned on a blog, but somehow it seems a distant worry.

The months turn to weeks before “the trip” , more internet research, restaurant reviews wet the appetite. “Oh, do I need a visa?” A thought may come to you on your way to work. The concept of a “travel agent” is not one that comes to mind now when we travel, unless it is a business travel. The internet may have made travel easier, however it marginalized travel agents.

Online searches on thevisa question and luckily with a US passport you need not worry. However, they mention health risks. I read and get a bit anxious about all these potential diseases that my family and I could pick up on our trip.

I put “call Doctor” on my to do list for the morning. I call in the morning, make an appointment to see him later in the week. Ten days to departure, shopping list getting completed. Doctor’s appointment was on a hectic day between work and kids, somehow I forgot to go to the appointment. On my way home I see a Pharmacy that has a yellow neon sign “Vaccines” flashing in the distance, I pull in and run in. The Pharmacy staff is pushing flu vaccines – I hear there is a quota system being used to maximize flu vaccine encounters at the pharmacy. Sensing that this is not where one would get a proper “travel consultation”. I go home and begin an online search for travel health information. ISTM – the International Society of Travel Medicine appears on top of the search page. This organization is a global organization with almost 3,000 members, in 70 countries. Their members can become certified in Travel Health, by passing a written exam.
Wishing I had done this earlier, I make an appointment for a consultation, 2 days before the trip.

At the office visit, the Doctor goes over risks at the destination, and recommends vaccines. However, due to the time factor only certain ones will be effective for the trip. I realize the proper way to plan a trip is to when I decide on a trip, make an appointment with an ISTM certified physician about 4-6 weeks prior to the trip. Packing a travel health kit that includes some OTC medications, insect repellants and other things is also a very important aspect of the pre-trip planning.

Recent world disease outbreaks – Ebola and Chikungunya Fever have been front line news. Getting the proper medical advise is crucial as all it takes is a slip up and then the consequences of that disease will become an issue that you would rather not deal with. Most travel diseases are preventable and treatable. One of the crucial aims of Travel Medicine is “not to bring home any infectious gifts!”. The old adage of “an ounce of prevention is better than a pound of cure” is very applicable here.

Rajiv Narula M.D. D.A.B.F.M. CTH
Medical Director
International Travel Health Consultants

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Small pox vaccination
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Small Pox by Dr. Rajiv Narula

Anthrax… Small Pox…Nuclear attacks…kamikaze middle eastern men …. Al kaieda….sounds like a suspense novel, no this is reality 2001. The new millennium that so many of us were looking forward to, has not been exactly been a predictable one. I started writing this column about 1 ½ years ago, as the title – Travel Medicine suggests, it has to do with medical issues faced by the traveler – usually when they were traveling. This column will deal with one of the above mentioned items – Small Pox . Even though there is no risk for travelers, this virus has been mentioned over and over again as a possible mode of a terrorist attack .

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Sun Safety by Dr. Rajiv Narula
The Sun had been worshipped by the Egyptians as Ra, amongst Hindus, Surya is the name given to this celestial body, without whose magical powers life would cease to exist. In the west the term ‘sun worship’ means trying to expose ones skin to the sun to darken it, in order to attain the perfect tan. For those of us who live in the northern climates, nothing feels better than the warm rays of the sun, especially after a long cold ‘sunless’ winter. There is nothing wrong in this new form of sun worship as long as it is in moderation and we pay attention to certain things.

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Road safety

Road safety
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Road Safety by Dr. Rajiv Narula

The peak travel season is on us, due to the slow down in the economy, there has probably been some reduction in spending towards leisure activities, like vacations. However in our Travel Clinic in NYC we are seeing a lot of travels who are going to locations like India, Peru, Bolivia, Thailand, Cambodia , China, etc. People travel for several reasons: for adventure, exploration, relaxation, see how other people live and for other countless reasons. During the pre travel consultation we do a risk assessment on possible health issue that will face the traveler at the destination. Most of the infectious issues are looked after with proper advice, vaccinations, medications, and sometimes with treatment if exposure occurs. One aspect of the talk has to do with road safety . Things that we take for granted here are – like road conditions/ traffic laws / vehicle safety do NOT exist is many parts of the world.

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Altitude sickness

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Altitude Sickness by Dr. Rajiv Narula

This column is being written in the beautiful Alpine City of Innsbruck, Austria, where I am attending a conference of the International Society of Travel Medicine. There are approximately 1700 attendees from 70 countries. There are various presentations ranging from jet lag to malaria to yellow fever to road safety etc. the common link is diseases or conditions that are encountered by travelers, and how best to prevent them. I will discuss the issue of altitude sickness, as it is becoming a common illness encountered by travelers who are finding themselves traveling to regions of the world, which were traveled only by a few people years ago.

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Traveling with children
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Traveling with Children by Dr. Rajiv Narula

With the overall increase in travel, this very important segment of society has also participated in the boom – the children. According to surveys done by Travel Association of America, nearly one half of US adults – 46% said that they had included a child/children on a trip in the past 5 years. Adding to these numbers are children of business travelers, who are increasingly traveling with their globe trotting parents.

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Insect Repellents

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Insect Repellents
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Maybe someday we will be using a commercially prepared version of crushed centipede on our skins to repel mosquitoes. A recent NYT article on this subject, described how certain African monkeys rub live centipedes (crunch-squish) over the bodies in order to keep mosquitoes from biting them. US studies on this underway, for now DEET and Permetherine are the repellents of choice for us humans .

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DVT
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DVT
by Dr. Rajiv Narula

Do an Internet search on ‘Economy Class Syndrome’ and you are likely to come up with a long list of articles/ links. The death of a 28 year old woman, after a 20 hour flight from Australia to England, from a blood clot in her lungs ,has been a popular news item in Australia and the UK. The Australian government and a British Parliamentary committee are commissioning a study on Deep Vein Thrombosis or DVT and its relationship to air travel. The person who coined the term Economy Class Syndrome, perhaps spent a restless part of their trip in the dungeons of an airplane – the ‘economy’ section. This section usually has fares advertised in national newspapers and when you call, they are usually sold or not available due to one of those reasons listed at the bottom of the page.

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Influenza Vaccine

Influenza Vaccine
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Influenza Vaccine
by Dr. Rajiv Narula

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The traveler and sexually transmitted diseases
by Dr. Rajiv Narula

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