Troubleshooting health issues while travelling

Nothing puts the brakes on a trip more than getting sick or injured. Despite a traveller’s best efforts to prepare and prevent common ailments while on-the-go, sometimes you might just have to troubleshoot health issues during a trip.

We spoke to numerous doctors to get their tips on dealing with the most common travel-related health problems, ranging from jet lag and sunburn, to bug bites and altitude sickness.

Altitude sickness
Blisters
Bug bites
Cuts
Deep vein thrombosis
Diarrhoea
Jellyfish stings
Jet Lag
Motion sickness
Muscle aches and pains
Sunburn
Upper respiratory infection (i.e. common cold)

Jet Lag

Danielle Wales, MD, MPH at Augusta Health in Fishersville, Virginia – who specialises in preventative medicine, public health and immunizations – shared the following information to prevent and avoid jet lag, and how to deal with it if it occurs.

Pre-Trip

• Here is what to pack:
  • Items to help sleep if you’re taking a long flight, such as travel pillow, earplugs and sleep mask.
  • Comfortable clothing for travel.
  • Some travelers use mobile apps, such as Jet Lag Rooster and Entrain to help adhere to a light/dark schedule prior to, during and after travelling.
• Before travelling, start adjusting your sleep schedule several days before your trip. If you are travelling west to east, go to bed and wake up one to two hours earlier. If travelling east to west, go to bed and wake up one to two hours later.
• Shifting mealtimes to accommodate these changes will help make the schedule change easier.
• Exercising before and after travel helps your body’s circadian rhythm adjust to the new schedule.

During the trip

No matter how much you prepare, if you get jet lag, here is how to cope.

• Do your best to adapt to the local schedule as soon as possible.
• Do not plan any critical meetings within the first day of arrival at your new destination.
• Eat well-balanced meals at the appropriate local time
• Stay hydrated.
• Avoid excess alcohol and caffeine, especially after midday, which can affect your circadian rhythm.
• Seek professional help: Travellers with diabetes who routinely inject insulin should consult their doctor to adjust their insulin schedule, if necessary, prior to long flights. Travellers who are being treated for sleep disorders with prescription medications should discuss use of their sleep aid medications with their doctor prior to travel as well.

Reference: Centers for Disease Control

Sunburn

Board Certified Dermatologist Dr. Douglas Wu, MD, Ph.D, FRCPC, FAAD of Cosmetic Laser Dermatology in San Diego, California, shares his advice to prevent and treat sunburn.

Pre-Trip

Here is what to pack:

• An SPF30 or higher sunscreen that contains physical blockers, such as zinc oxide and titanium dioxide.
• Protective clothing, such as a broad brimmed hat to keep direct sunlight off the head and neck

During the trip

• Reapply sunscreen every two hours. The effectiveness of the sunscreen will wear off naturally with sweating and water exposure, so reapplication is important to maintain protection.
• Stay out of direct sunlight between the hours of 12 p.m. and 4 p.m.

If you get a sunburn…

• Typically, sunburn presents with tender redness and superficial peeling. These don’t usually require specialized treatment. Keep the area clean, avoid re-exposure to the sun, and consider taking a low dose of ibuprofen or acetaminophen if the discomfort is too much.
• Seek professional help: On rare occasions, severe sunburn can lead to large blisters and more significant skin breakdown. When this happens, a qualified medical professional should be engaged to apply simple dressings and wound care.

Traveller’s Diarrhoea

Michael Zimring, Director of Wilderness & Travel Medicine at Mercy Medical Center in Baltimore, Maryland. and co-author of Healthy Travel: Don’t Travel Without It!, provided the following information to prevent and avoid diarrhoea and how to deal with it if it occurs.

Pre-Trip:

• Pack a good supply of Imodium and the most appropriate antibiotic to treat diarrhoea.
• See a certified travel doctor for a pre-travel consultation. He or she can prescribe the most appropriate antibiotic: cipro, levoquin, azithromycin and rifaximin and discuss the pros and cons for each one, including side effects that can be significant and antibiotics that can be resistant in certain parts of the world.
• Get the appropriate vaccinations of Hepatitis A & B and Typhoid Fever.
• Get travel insurance for medical care and evacuation.

During the trip

It’s best to be in control of your own food preparation while exercising good hygiene. Always wash your hands before meals. Make sure you are well hydrated on your trip

Avoid diarrhoea by staying clear of the following foods and drinks:

• Dairy products
• Salads and raw vegetables, especially leafy greens
• Raw seafood
• Under-cooked meat
• Condiments, such as salsas sitting on a restaurant counter top
• Ice (note: freezing does not kill bacteria)

Instead, look for these foods:

• Freshly cooked and piping hot foods
• Cooked vegetables and personally peeled fruits washed with clear bottled water.
• Brand name and sealed bottles of water (it’s best to use carbonated water)
• Freshly prepared coffee or tea, beer and wine (note: boiling water one to three minutes kills bacteria)

If you get diarrhoea…

Here’s what to do if you get diarrhoea:

• Mild: Hydration, hydration, hydration – plus take Imodium
• Mild to moderate: Take cipro, levoquin, azithromycin or rifaximin, based on the advice of a certified doctor
• Seek professional help: If the diarrhoea lasts more than three to five days, or if it gets bloody, or you get dehydrated and cannot take oral fluids

Altitude Sickness

Eric Johnson, MD, associate medical director of travel risk and crisis management firm Global Rescue, is an expert in wilderness and altitude medicine and is a past president of the Wilderness Medical Society. Dr. Johnson serves on the Board of Directors of the Himalayan Rescue Association and is a founding physician at Mt. Everest ER, the medical clinic located at Mt. Everest Basecamp. He shared his altitude sickness advice with us.

Pre-Trip

Pack the medicines you might need:

• For a headache, you can take aspirin, acetaminophen, or ibuprofen.
• There are also prescription medicines that should only be used under the guidance of a doctor. These medicines can help treat the symptoms of acute mountain sickness. These include:
  • Acetazolamide: This medicine can help prevent and treat acute mountain sickness.
  • Dexamethasone: This medicine can help keep the symptoms of acute mountain sickness from getting worse and it can help prevent swelling of the brain. It is intended for very short-term use (a few days) and if used, descend immediately.

During the trip

The best way to prevent altitude sickness is to avoid moving quickly to a higher altitude. Going slowly gives your body time to adjust.

• If you are travelling to a very high altitude, plan to stretch your trip out over several days.
• If you are hiking or climbing, don’t do difficult physical activities for the first few days, and avoid alcohol and sleeping pills.
• When hiking, go to a higher altitude during the day and then go back down to a slightly lower altitude each night to sleep.
• If you have had altitude sickness before, your doctor might give you a medicine to keep you from getting it again.

If you get altitude sickness…

Treatment depends on which type of altitude sickness you have.

Acute Mountain Sickness: Acute Mountain Sickness is the most common and least dangerous type of altitude sickness. The symptoms mirror those of a bad hangover and typically start at 8,000 feet in elevation. Symptoms usually start within a day or two of travelling to a new elevation and can include:

• Headache
• Feeling tired
• Feeling lightheaded
• Loss of appetite
• Trouble sleeping
• Nausea, sometimes with vomiting

If you have mild symptoms of acute mountain sickness, rest and stay where you are until you feel better. Do not travel or climb to a higher altitude until you feel better and all symptoms resolve. Moving to a lower altitude can also help if symptoms do not go away in a day or two.

High altitude cerebral edema (HACE): This is less common but more serious than acute mountain sickness. It involves swelling of the brain and usually involves symptoms of AMS but with worsened brain symptoms (commonly an inability to walk in a coordinated fashion).

The symptoms of HACE (swelling of the brain) usually start one to three days at a high altitude. They include:

• Extreme tiredness and weakness
• Trouble walking normally
• Confusion and irritability
• Acting drunk

High altitude pulmonary edema (HAPE): This is also less common and more serious than acute mountain sickness. It involves fluid build-up in the lungs.

The symptoms of HAPE (fluid in the lungs) usually start two to four days after travelling or climbing to a high altitude. They include:

• Coughing
• Feeling breathless, with worsening exercise tolerance
• Trouble walking uphill

Seek professional help: If you have severe symptoms after travelling or climbing to a high altitude, get medical attention immediately. Waiting for treatment could cause serious health problems, or even death.

Motion Sickness

Danielle Wales, MD, MPH at Augusta Health in Fishersville, Virginia. who specialises in preventative medicine, public health and immunizations, shared the following information to prevent and avoid motion sickness and how to deal with it if it occurs.

Pre-Trip

Consider packing the following:

• Over-the-counter medication, such as diphenhydramine, dimenhydrinate, meclizine.
• If over-the-counter medicines do not work, your doctor may prescribe scopolamine patches.
• Before using these medications: Read instructions on label completely and speak to your doctor or pharmacist if you have questions. Before travelling, take a dose before leaving so you can see how the medication affects you.

During the trip

• Limit alcohol and caffeine
• Drink plenty of water

If you get motion sickness…

• Try to plan your seating arrangements accordingly. When on a plane, try to sit over wing. If driving, sit in the front seat. If on a train, sit facing forward.
• Limit sensory input by closing eyes or looking out towards horizon. Avoid reading.
• Take over-the-counter medication or doctor-prescribed scopolamine patches. Before using these medications, read instructions on label completely, and speak to your doctor or pharmacist if you have questions. If you plan on using these medications before travelling, take a dose before leaving so you can see how the medication affects you. A common side effect of these medications is drowsiness. You should not drive a car or operate heavy machinery while on these medications.
• Seek professional help: If you are pregnant, discuss safe medication choices with your OB/GYN.If you are travelling with children, discuss safe medication choices and proper dosing with your child’s pediatrician. If you are on multiple medications, discuss the risks, benefits and possible side effects of motion sickness medications with your doctor or pharmacist.

Reference: Centers for Disease Control

Jellyfish sting

Dr. Douglas Wu, MD, Ph.D, FRCPC, FAAD of Cosmetic Laser Dermatology in San Diego, California, shares his advice to preventing and treating jellyfish stings.

Pre-Trip

If you travel to an area with jellyfish risk, you will need:

• Gloves
• Forceps
• 1% hydrocortisone cream
• Antihistamine

Jellyfish have stinging elements within their tentacles called ‘nematocysts’. Removal of these stingers is one of the first steps of treatment but that requires gloves and forceps. Also, a 1% hydrocortisone cream and an antihistamine pill can help alleviate the symptoms so consider packing these items.

During the trip

Jellyfish are most prevalent in calm, warm seawater, sandy beaches and harbors during the summer months. So watch where you step and check with some knowledgeable locals for a better assessment of the risk in the waters of your destination

If you get stung by a jellyfish…

• Immediately remove yourself from the water – the pain of the sting may be severe and can hinder your ability to stay afloat!
• Do not rub the area as that can trigger more discharge from the stinging nematocysts.
• If you have gloves and forceps, carefully remove all the stingers you can see.
• Soak the affected area in warm salt water – not fresh water, as this can also trigger more discharge from any remaining nematocysts.
• Apply ice to the area for pain relief.
• Check with the local medics to find out if there is an antivenin available at your location.
• Apply a topical corticosteroid cream and take an antihistamine pill to alleviate the symptoms.
• Contrary to popular belief, urine and alcohol can actually make things worse so don’t apply them!
• Seek professional help: Always check with local health care professionals after a jellyfish sting as there are antivenins available for specific species of jellyfish that may be prevalent in your location

Bug bites

Dr. Douglas Wu, MD, Ph.D, FRCPC, FAAD of Cosmetic Laser Dermatology in San Diego, California, shares his advice to preventing and treating bug bites.

There are a huge variety of bugs that can cause skin reactions ranging from ticks, mites, fleas, flies, bugs, mosquitoes, ants, spiders, and everything in between. For the run of the mill mosquito, a good insect repellent can come in handy. Proven insect repellents include products that contain DEET, IR3535 and/or Picaridin. Pack these prior to your trip.

During the trip

• It’s important not to scratch a bug bite as this can lead to unsightly scars, skin breakdown and increased risk of infection.
• Applying a cold compress can help alleviate the itch.
• Calamine lotion, which contains zinc oxide, can be soothing and is safe to use on mosquito bites.
• Seek professional help: Some bug bites can be dangerous, in particular, spiders, ticks, and ants. If the bite is extremely painful, results in skin discoloration, has severe blistering, or is characterized by progressive and spreading redness, a health care professional (and preferably a dermatologist) should be consulted.

Blisters

Dr. Douglas Wu, MD, Ph.D, FRCPC, FAAD of Cosmetic Laser Dermatology in San Diego, California, shares his advice to preventing and treating blisters.

Pre-Trip

Here is what to pack:

• Saline rinses and clean bandages can be helpful if you develop blisters, especially if they get eroded and break down.
• Appropriately fitted footwear

During the trip

Most blisters are due to repeated friction in areas of high stress like the feet. The primary preventative measure is to ensure appropriately fitted footwear, especially if you’re planning on taking long walks.

If you get a blister…

The best thing to do with a blister is usually to leave it alone and it will naturally resolve. This way, the overlying skin of the blister acts as a natural “wound dressing” that promotes healing and prevents infection.

Seek professional help:

• If the blister becomes painful, red, swollen, or has malodorous discharge, these may be signs of infection and should be evaluated by a health care professional.
• Sometimes the fluid build up within a blister can be too much and requires drainage. In this case, it’s best to see a health care professional who can do the drainage procedure in a safe, clean environment.
• If you’ve developed a blister not due to obvious friction, pressure, or trauma, it’s best to seek consultation with a dermatologist as there are many different types of blistering conditions and some can be quite serious!

Upper respiratory infection (i.e. common cold)

Dr. Ernest Brown, founder and CEO of the on-demand concierge service, Doctors To You, that provides house calls in Washington, D.C., shares advice on preventing and treating upper respiratory infections (i.e. the common cold).

Pre-Trip

Avoid medications that are all in one. There is no magic pill despite what may be advertised. Often they contain more than you need and also have side effects, such as drowsiness and are contraindicated for patients taking hypertension medication.

Dr. Brown packs:

• Zicam: To boost your immune system. As soon as you identify a scratchy throat or stuffy nose take Zicam Rapidmelts. The trick is to place the lozenges inside the cheek and not on the tongue. This keeps the zinc in place longer and reduces any associated upset stomach.
• Tylenol ES: To reduce any fever or aches. Less irritating to the stomach.
• Afrin and nasal saline: To relieve sinus congestion and nasal saline for good hygiene, which helps prevent subsequent bacterial infections leading to sinusitis and bronchitis?
• Mucinex: is good for thinning secretions, but only really works when you’re adequately hydrated.

During the trip

Since the common cold is an acquired infection, the best practice is to reduce exposure to others who are sick. No easy task in an airport, of course. This means kindly asking others to cover their mouth when coughing. Also being mindful of contact surfaces that may be contaminated and using hand sanitizers frequently in high-traffic areas. But the best practice to keep healthy by drinking more fluids, eating healthy foods, trying to remain relaxed, and dressing appropriately for both hot and cold conditions.

If you get a cold…

The key is to treat early and aggressively. Often patients wait too long between identifying they are sick and starting treatment. Your body should be able to fight off the virus if you’re in good health, but the primary concern is that the infection will lead to a secondary bacterial infection, which is often the case for sinusitis, ear infections and bronchitis.

Take over-the-counter medicines recommended under the ‘Pre-Trip’ section.

Seek professional help: Muscle and body aches are not associated with the common cold, but they are with influenza. Treatment for the flu is now very effective with Tamiflu, but you need to know that treatment with this medication must occur within 48 hours of the start of symptoms. Patients often wait too long to get help, therefore making the medication less effective. Also, the sooner you start, the sooner you will recover. Prolonged, high fever for more than five days is a concern and should be evaluated by a doctor to make sure the infection is not more serious. Having a persistent cough is expected, but, if longer than 10 days, then you should, at the very least, have a doctor listen to your lungs.

Cuts

Danielle Wales, MD, MPH at Augusta Health in Fishersville, Virginia. who specialises in preventative medicine, public health and immunizations, shared the following information to prepare for cuts and how to treat them.

Pre-Trip

• Pack the following:
• Bandaids and non-stick bandages
• Antibiotic ointment, such as bacitracin
• Make sure your immunizations are up-to-date, particularly your tetanus booster. For adults, you should receive your tetanus booster once every 10 years. Children should be up-to-date with all of their vaccines before travelling.

During the trip

• Wear appropriate protective gear for the activity you are doing. For example, helmets when cycling. Always wear a seat belt where available.
• Be careful when handling sharp objects, such as knives and scissors. Use protective cases with sharp objects, if available.

If you get cut…

• If only the skin appears to be damaged, you are likely dealing with a simple cut. Wash your hands first before addressing the cut. Then, wash the wound with water. Apply antibiotic ointment and cover with a bandage.
• If you think you can see anything deeper, such as fat, muscles, tendons or bone, seek help immediately.
• Seek professional help: If you have a cut that is:
• Greater than 3mm.
• Continues to bleed, despite applying direct pressure for more than 15 minutes.
• Contains dirt or debris, despite attempting to clean it out. If an object has punctured the skin and is stuck, such as a fishhook, do not attempt to pull it out.
• Is located over a joint, such as knuckles, knees or elbows
• Cuts over areas, such as the face, may also require stitches so to minimize any scarring
• If the affected area does not seem to be working right (for example, is numb).
• If you have treated a cut, but it is becoming extremely painful, red, draining material that looks like pus, or you have a temperature greater than 100 degrees Fahrenheit. Sometimes cuts may get infected, and antibiotics may be needed.

Reference: U.S. National Library of Medicine

Muscle aches and pains

Dr. Ernest Brown, founder and CEO of the on-demand concierge service, Doctors To You, that provides house calls in Washington, D.C., shares advice on preventing and treating muscle aches and pains.

Pre-Trip

Pack the following:

• Tylenol and ibuprofen: To help reduce pain and inflammation. I often use both in combination, overlapping every 4 hours for at least 48 hours.
• Sports drink powders: To pre-hydrate. I use Vega Pre-workout Energizer, which comes in convenient individual packets, which I add to bottle water. Many sports drinks come with too much added sugar, which is not beneficial.
• Calcium/Magnesium powder or tablets: To balance calcium and magnesium. I use Natural Vitality Cal/Mag powder, which I supplement with the Vega Energizer. Muscle aches and pains is your body telling you something is not right. It may be related to overexertion but it is often associated with dehydration and an electrolyte imbalance such as low potassium, calcium, or magnesium. Some prescription medications can exacerbate electrolyte imbalances so be sure to review with your doctor any possible side effects.

Important: Medications for diabetes and high cholesterol can cause muscle pain
so be sure to review those as well.

During the trip

• Hydrate: Hydration is key to good muscle function, reducing fatigue, and preventing aches and pains. 2 liters a day is a good general rule.
• Stretch: To help keep the body limber and agile. Tight muscles are more likely to be injured than muscles that have been stretched. Stretch for 15-30 minutes first thing in the morning.
• Icing/salt compress: To reduce inflammation and spasms. If I have had a particularly strenuous activity and I already feel my muscles tightening, then I take ¼ cup Epsom salt and add to 1 cup of water to dissolve then throw in some ice to cool it down. I then take a hand towel to soak up the solution and wrap it over the area, i.e. calves, lower back, arms, etc. I do this for 30 minutes and try to repeat every 4 hours.
• Rest/Sleep: To recharge the body and restore balance. Plan to take breaks between activities. Going for long stretches without rest puts more stress on the muscles and is more likely to lead to electrolyte imbalances. Sleep restores balance to the body. Poor quality sleep means tighter muscles in the morning. I always carry wax earplugs and a cover for my eyes.

If you get muscle aches and pains…

• If you experience muscle aches and pains, immediately increase your hydration. Not just with water but fluids high in electrolytes, such as coconut water, a good sports drink like Vega Recovery, or, if possible, a cold-press green juice.
• Rest and icing are the next steps.
• NO HEAT! Even though it may make the muscles feel better, it can worsen the inflammation and cause a spasm to take hold.
• Continue stretching as this helps reset the affected muscles.
• Start taking Tylenol and ibuprofen on a regular schedule for the next 48 hours.
• Seek professional help: If a muscle group has locked into a spasm then it will be necessary to seek medical attention. Certain medications can be used to relax the muscles but they can make you drowsy which means no alcohol while you are taking them. Stronger anti-inflammatories can be provided by prescription or injection. Apart from seeing a doctor, I always recommend a consultation with a physical therapist or chiropractor to do an assessment, provide treatment and discuss prevention.

Deep Vein Thrombosis

Danielle Wales, MD, MPH at Augusta Health in Fishersville, Virginia. who specialises in preventative medicine, public health and immunizations, shared the following information to prevent and avoid Deep Vein Thrombosis and how to deal with it should it occur.

It’s important to know that anyone can get a Deep Vein Thrombosis, but certain people are more at-risk. These people include:

• Those with a personal or family history of blood clots
• Recent surgery or injury (especially if it limits mobility)
• Older age
• Obesity
• Patients with active cancer
• Pregnant women
• Use of birth control or hormone-replacement therapy
• Any person whose mobility is limited.

The danger with DVTs is that a small piece of the clot may break off and travel to your lungs. This can be life threatening.

Pre-trip

If you have one of the above risk factors above, your doctor may recommend compression stockings or medication to reduce your risk of developing a blood clot.

During the trip

• Drink plenty of water
• Stand up, walk around, and stretch your legs every two to three hours.
• While sitting in your seat, exercise your calf and leg muscles. These exercises include toe raises and heel raises. Some people like to make games out of these exercises, such as spelling the letters of the alphabet with their toes.

If you get deep vein thrombosis…

• Seek professional help: Seek help immediately if you develop pain, swelling and/or redness in one of your legs.
• If you have recently travelled and are having difficulty breathing, chest pain, lightheadedness, fainting, coughing up blood or fast heart rate, call 911 immediately.

References: Centers for Disease Control

(Main Image: Guian Bolisay, Best of the Best via Flickr CC BY-SA 2.0)