TRAVEL MEDICINE

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TRAVEL MEDICINE

• TRAVEL HEALTHY
• AND
• SMaRT
• 2006!

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• The preparation for tomorrow
• is the correct use for today!

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Before We Go!

• Most medical emergencies encountered
  while traveling are the result of accidents..not
  illness or disease

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Most medical travel problems are avoidable Know
yourself!!!!!
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Personal Medical Inventory

• Am I ready for this trip?
• What diseases (chronic and acute) am I bringing
  with me?
• How can I prevent an avoidable problem?
• Common disease present common problems here and
  abroad!

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Most Common Illnesses

• Death- HEART Disease!
• Trauma ( motor vehicle-25!!)
• Acute Illness-diarrhea (GI), respiratory
• Hepatitis A ( most common preventable)
• Motion Sickness ( most common annoyance)
• 
  CDC 2000

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Prevalence of health related Problems
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T.I.P

• Travel Informed and Protected!
• Ensure you have had a recent medical and dental
  evaluation (do not put off the obvious prior to
  the trip)
• Check with your Primary Care provider

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T.I.PPrescription Medicines

• Take medication inventory
• Quantity?
• Beware of Delays!!!!!
• DO NOT PLACE MEDS IN CHECKED BAGGAGE!
• Be aware of security requirements
• If there is a ? -bring signed Rx from your
  physician for all medications

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T.I.P. Rx

• Medications should be taken at the appropriate
  time in the sleep wake cycle
• Exception-during travel-some medications may need
  to be adjusted (insulin, anti-reflux medications,
  seizure medications..)

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T.I.P.Medications

• Account for travel delays!
• List of generic names for all medications
• Where possible medications should be in their
  labeled container

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T.I.PChronic Illness

• Consider bringing a medical history form with you
  (on your person not in suitcase)
• Medical history forms! (we have a copy) HIPAA
  compliant!
• Ask your personal physician regarding their
  concerns with your traveling
• Traveling companions should be made aware of your
  medical issues (where necessary) (ALLERGIES!)
• Buddy System!!!!!!!!!

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T.I.P.Prolonged Air travel

• Cabin Altitude - Kept at 2,450 m (reduced Oxygen
  tension)
• Majority of travelers not affected!
• Chronic Pulmonary (and cardiac) patients may be
  affected
• Reactive Airway Disease (asthma)
• Smokers - maybe affected!!!
• Small Spaces????

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T.I.PCabin Altitude

• No Smoking!!!!!
• Prolonged time away from nicotine might induce
  withdrawal symptoms! (consider gum or patch!!)

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T.I.P. Ear Squeeze (ache)

• Ambient pressure in the cabin is less than sea
  level
• Balance between inner ear and ambient pressure is
  not equal increased pressure in the inner ear
• Pain, Vertigo, Nausea!

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T.I.P.

• At risk- acute and chronic sinusitis
• Inhalant allergies
• Smokers
• Patients who are sensitive to decrease humidity!

• Effective Measures Nose spray-saline,
  astringent
• Decongestant (watch for side effects)
• Chew gum
• Yawning
• Valsalva

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T.I.P.Nausea

• Do Not Fly on an empty stomach!
• Vitamin B1 (foods - artichokes, fish, oatmeal,
  rice, asparagus
• Ginger-tea, ale, green tea
• Sit in center of plane near or over wing
• Fix eyes on a distant portion of the horizon
• Anti emetics (bring them with you if you are
  prone!)

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T.I.P.Deep Vein Thrombosis

• RISKS Smoker, overweight, previous DVT, oral
  contraceptives, phlebitis, diuretic use
• Previous history
• Female
• Over 40

• Prevention-
• legs not acutely bent
• drink water
• avoid dehydration (caffeine, alcohol)
• Stretch
• Frequent walks
• Compression socks
• ASA?

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T.I.P.Jet Lag

• Rapid change to new time zones alters the sleep
  wake cycle (swc)
• SWC-adjusts internal regulatory hormones and can
  be longer than 24 hours!
• Decreased reaction time
• Alteration in wakefulness
• Decreased concentration

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Jet lag

• Decreased memory
• Alteration in appetite, nausea headache
• Ability to concentrate

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Jet Lag

• East bound
• Biologic rhythm slightly greater than 24 hours!
• Sleep!
• Carbo. gt Proteins
• Set watch to destination
• Sunlight reduction!

• West bound
• Move - walk
• Increase fluid intake (no alcohol)
• Proteingt carbos
• Avoid tyrosine (turkey!)
• Increase sunlight exposure upon arrival
• Caffeine
• Day Longer

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Ehrets Diet
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Ehrets Diet

• A scientific method of eating your way to health.
  Clears up mystery of latent, acute and chronic
  diseases. Reveals the formula of vitality.
  Explains the enforcement of elimination by diet
  reform. Ehret's system is more an education than
  a personal treatment. Recognizing that Nature
  performs no rapid miracles when healing the body,
  but rather demands proper compensation for the
  former wrong living and eating habits. The
  Mucusless Diet Healing System is for anyone
  desirous of learning that greatest and most
  valuable of all knowledge, How to Control Your
  Own Health. How to live longer and
  understandingly meet every bodily and mental
  sensation ( reduce travel fatigue)
• Not Proven but wouldnt hurt!!!!!

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Ehret Dieteast-west

• Determine breakfast time at destination
• Diet cycle- 2 to 4 days prior to embarkation
• Day 1- FEAST ( high protein breakfast and lunch-
  High carb dinner- NO cola, coffee, tea
  i.e.-CAFFEINE!
• Day 2- FAST light meals, fruit, salad NO
  Caffeine!

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• Day 3-Feast Repeat!
• DAY 4----TRAVEL Caffeine in the morning only!
• Attempt to sleep till the morning at your
  destination
• First Day- High protein breakfast
• Resume semi normal diet there after!

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Jet Lagwestbound

• Avoid-Sleeping pills, melatonin, alcohol
• Decrease - exercise

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Westbound

• Turn on Lights
• Stay outside until dusk
• Awaken early in the morning
• CAFFEINE! ( YUP Caffeine!!!!!)

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T.I.P.DM!

• Injection plan
• Double the quantity of medications you would need
  during the time away (bring more with you - do
  not double dose!!!!!!)
• Insulin should not be exposed to extreme
  temperature changes
• Rx from your physician
• Westbound- extra meal during travel!

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Personal Medical Kit

• EPIPEN- if you have a severe allergy
• Safety pins
• Small scissors (pack do not carry on plane!)
• Band-Aids (blister treatment pack)
• Alcohol wipes
• Personal wipes (baby wipes!)
• Antiseptic skin swabs
• 
  Rx

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• Pocket skin cleanser
• Antacids
• Antifungal cream
• 1 hydrocortisone cream
• Antibiotic ointment
• Oral thermometer
• Analgesic (ibuprofen, acetaminophen)
• Benadryl

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• Pepto-Bismol (tablets)
• Spare glasses
• Sunglasses
• Eye moisturizer
• Skin moisturizer
• Benadryl spray
• Contact solution (prescription)

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Medical care-in country

• Germany, Belgium,Swtizerland, Netherlands, Italy
  equivalent quality to U.S.
• Medications easily available
• Obtain insurance (most U.S. policies will not
  cover!)
• Trip insurance can cover medical flight home!!!

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Medical Systems

• Germany- social system where all insurance is
  provided by employment- quality A
• Netherlands- combines American and German system-
  Quality A ( need referral for care hotel can
  provide- emergency care similar to US)
• Switzerland-free care to al EU member
  citizens-care and quality A ( expensive!!!)
• Italy- Similar to UK ( all EU citizens will
  receive care- Quality A

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Common Sense

• Clearly common sense should prevail
• If you would go to physician for a complaint
  here- Consider going while traveling!
• If illness is serious enough that you would need
  to stay in the room for a few days Consider
  returning to U.S. ( if you have the insurance)

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Common Sense

• Consider others-
• Close quarters!!
• Hand washing!
• Anything you would tell your kids to do practice
  yourself!!!
• Goal Safe and Healthy travel for ALL!!

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• CDC's Yellow Book--Internet address
  http//www.cdc.gov/travel/ http//www.magellans.co
  m
• Access America600 Third AvenueNew York, NY
  10163Phone [phone]Policy will cover
  medical complications of pregnancy through the
  third trimester. Pays for scuba diving injuries.

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• ASA, Inc. International Health InsurancePhoenix,
  AZ1-888-272-8288
• Travel Assistance International (A Europe
  Assistance Company)9200 Keystone CrossingSuite
  300Indianapolis, IN 46236Phone [phone]

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QUESTIONS?