Well, first and foremost, you want to make sure that you're going where you want to go and where your health needs will allow you to go. There are certain places that may seem very alluring, but you must consider the personal health risks that you’re going to undertake when you go into some of these places, and also what your fitness level is.
You want to make sure that you have your passport in order and all the basics, and then finally check the health information advisories that are available for the destination you plan to visit.
You want to make sure that you feel physically confident in where you want to travel. For example, if you want to plan a long hike, make sure you practice at home. Make sure your fitness level is up to speed. Check in with your primary care doctor and let them know about your travel plans and what you want to do.
There’s so much information available now on the Internet. There are many websites that are very useful. TripAdvisor is a good website. There are forums available there for topics of any discussion. CDC.gov (Centers for Disease Control and Prevention Travelers' Health) is an excellent website and it’s the primary website that we use at Scripps to check travel advisories. It’s a comprehensive, current, very up-to-date resource for what is a concern when traveling abroad, and not just about health risk, but also political risk, which also plays into safety. So that’s the site that you should check before you travel anywhere.
Malaria is a common concern that we advise patients to learn more about because there is prophylaxis. Meaning there is medication one can take to help prevent getting malaria. So, you need to know where there is malaria.
Recently Zika virus was in the news and that’s something you should know about, especially if you’re trying to get pregnant or if you are pregnant, in order to know what areas to avoid. Also, traveler’s diarrhea, which is very common and not necessarily seasonal. It’s important to learn where that is more common and where you are more at risk for acquiring symptoms related to traveler’s diarrhea.
In Mexico, Zika has been a common concern recently. Traveler’s diarrhea, often called Montezuma's revenge, is always a concern. Those are things that one should guard against and be aware of. Mosquito-borne illnesses are not as common in certain parts of Mexico, but Mexico has a lot of climate variability, so you have to look at that. The CDC has recommendations based on where you’re going in Mexico.
Africa is huge and there are so many different diseases that are endemic there. Yellow fever is one. There are some places in Africa where you are not allowed to enter without proof of yellow fever vaccine. So, that is an important consideration and that requires very careful planning. Also, dengue fever, which is a mosquito-borne illness. Malaria is also a mosquito-borne illness. Some of these diseases have medication you can take to help prevent them. Others don’t, but require preparation in terms of mosquito repellent for your clothes and for your skin. Also consider your children, who may require different types of medications and different doses. There’s variability in ages as well.
South America is very diverse like Africa. There are some places that also require yellow fever vaccine. There is malaria risk in parts of South America. Other parts, there’s no malaria risk. Traveler’s diarrhea can always rear its ugly head. So that’s always a concern.
In Asia, there are pockets where there is malaria. There is dengue fever. So, those concerns are still there. There are some areas where rabies is a concern, such as where there are wild animals, wild dogs, like in Southeast Asia, for example. There may not be a specific medicine you have to take, but the awareness is important. How to reduce your risk is important.
Vaccines are key in preventing illness and that includes your routine vaccines. So, make sure your tetanus shot is up to date. Most tetanus vaccines will be Tdap, which will contain protection not just against tetanus but whooping cough and also pertussis and diphtheria. Also get your flu vaccine. Flu vaccine is a seasonal vaccine. Make sure you have that. Flu is widespread. It is worldwide, and it can be a very serious illness.
There are other more destination-specific vaccines, such as yellow fever. There is a typhoid vaccine. There is also a polio vaccine. We don’t see polio as much in the US, but it is present in other parts of the world.
It’s never too soon to plan. Sometimes planning is a big part of the fun. Planning safely adds to the fun. I always tell my patients to let me know as soon as you have an idea of where you are going to go, and we can tee up your vaccines.
Some of these vaccines may last 10 years. Hepatitis A for example, done correctly, spaced over six months, can give you 10-year immunity. If you plan soon enough, then you can separate that out from your typhoid vaccine, for example. You want to make sure and get your vaccines no later than a month before you're traveling.
I remember doing a hike in Thailand that was a bit harder than I thought it would be. The climate was different. It was very humid. We enjoy very nice, temperate weather here in San Diego, and I had done my training for that in San Diego. Knowing your personal limit includes accounting for variability when you travel. Talk to your doctor about that and be very honest with yourself. This is not the time to bolster your efforts and be false about what you can do simply because you want to do it. You could run into trouble if you push yourself too hard and suffer from heat exhaustion or something more serious, such as a heart attack or high-altitude sickness, which can be very serious. So, make sure your doctor knows of your plans. Be very candid with your doctor. Be very honest with yourself about what you can do and about what you have done before.
Because we are at sea level, you want to make sure to give yourself time to get used to a high-altitude place and its climate — if you’re going to the Rocky Mountains, or if you’re going to Machu Picchu to do a hike there. You want to give yourself a few days. The more time you give yourself, the more you will enjoy your trip, the more fit you will be during that experience. There’s also medication to help decrease the risk of altitude sickness. Those symptoms could be anywhere from headaches to more serious symptoms that involve shortness of breath or severe illness. So, time is very important. Giving yourself time when you arrive at your destination to get used to the altitude and the climate is very important.
A first aid kit needs to be very basic and it should be something that you can have ready. Always include basic analgesics, which is pain medication like Tylenol, Ibuprofen, a Band-aid kit, topical antibiotic and cortisol cream. Those are the basics that I’d recommend.
As for medications, it’s best to always keep them with you. Never check them. Even insulin syringes, keep that with you. Anything that you need that’s an essential medication, you should take with you as a carry on. It’s always best to keep them in the original bottles that have your name and the exact prescription. Sometimes they are looked at security. But it also avoids confusion if you need to go and access health care when you’re abroad. Then, you can show the medication in the pill bottle. We may not always be able to speak another language, but doctors will often recognize medication in its original prescription form. So, that’s helpful.
Generally speaking, urban destinations tend to be very easy in terms of accessing health care. Oftentimes, pharmacists have more leeway abroad in making health care recommendations and giving medications than we do here in the US. So, that can be helpful, but you also need to be cautious.
Check your health insurance. It’s a good idea to let them know that you’ll be traveling abroad and check and see what the coverage is. Also getting specific trip insurance that includes health care coverage is important. When you do select your trip insurance, then ask about evacuation, which isn’t always included. But that may be helpful in the event of an emergency or an injury.
Also, let your credit card service know. Credit cards nowadays do have health insurance coverage and medical insurance benefits that can be helpful. So, getting as much coverage as you can is a good idea.
Access is very variable especially if you have a very chronic health condition. Make sure you know what your options are for health coverage when you go. All the more reason to be prepared. Plan ahead. Take your medicines with you. Take a summary, a written summary. Even get a letter from your doctor. I’ve been happy to write this for many of my patients for them to show the airline or tour group, just detailing somebody’s specific needs or specific health care requirements. This may include whether somebody may need extra breaks or extra rest. You want to err on the side of caution. Give yourself a break. You’re going on vacation to enjoy your time and not to test your limits.
Seniors need a different flu shot. They should have a different flu shot that bolsters their protection against influenza. Children also have pediatric doses. There are also dosing differences for malaria prophylaxis, the medicine that we prescribe to prevent malaria. Children have a different dose and that depends on weight. Sometimes it depends on age. Then there are certain health conditions that make it necessary to get one vaccine over another. So, age and also underlying health conditions also make a difference in terms of what vaccines you need.
Vaccines for seniors are very important. Seniors are at higher risk for getting severely ill from something like influenza. Doses may be different. The senior flu shot, for example, is a different dose than the traditional flu shot. The pneumonia vaccine is another important one for seniors. That’s one of the routine vaccines we recommend whether you’re traveling or not. It’s especially important to make sure that is current and up-to-date before traveling.
We talk about economy class syndrome. Not all of us can afford a business class seat where we can stretch out and have our leg circulation be optimal. When you’re sitting for long periods of time or even lying in that business-class seat, then blood circulation isn’t as it is when we are walking around at home. Blood clot is a risk.
It’s important to stay well hydrated. Wearing loose clothes or comfortable clothing is important. You don’t want to have restrictive clothing that may look really nice for the selfie or the Instagram post, but you want to have comfortable clothing that you would want to wear at home when you’re lounging around. I tell my patients, think about pajamas for travel. That's how you want to feel on long haul flights.
You want to avoid alcohol as much as possible and drink a lot of water. Keep in mind that airplane food tends to be very salty, so you may swell more. Your legs may swell more. You want to drink more water. When they come around asking you to drink or offering you more water or asking you if you would like a beverage, always say yes.
You should be drinking enough water so that you actually have to get up out of your seat and use the restroom every couple of hours.
It’s important to stand and walk as much as possible during the flight. When you're sitting in your seat doing what I call the ABC exercises are very helpful. You just draw the alphabet with your foot. That puts your ankle through a range of motion and gets the blood pumping in your legs. That’s a poor substitute for walking but it does help. As soon as you can get up when the aisles are clear, get up and walk up and down as much as you can. If you can get up every couple of hours, that’s optimal.
When you’re sitting, even though you have to sit with your seatbelt on, you can still move your legs around doing the ABC exercises. I tell my patients also to get some compression stockings. Those are widely available. They’re much more attractive than they used to be. You can order them online. You can buy them in the major department stores and even at drug stores. They do help decrease swelling and they do help decrease risk of blood clot.
You can’t really prevent it, but you can help minimize the effect of jet lag. Staying hydrated, avoiding drinking alcohol, choosing flights that will put you at your destination when you are ready to go to sleep are important.
If you have an overnight flight, it’s better to sleep on the plane, allow yourself to travel at a time when you know is comfortable for you. If you arrive at your destination when it’s morning or daytime, don’t go to your hotel room and go to bed. Stay awake when the sun is up, and go to bed when the sun goes down. So, immediately getting yourself into the time zone of your destination will help. The other thing is to set your clock ahead. Set your watch ahead as soon as you get on that plane, and start thinking of the time of your destination and not constantly referring to the time of home. So many people will keep their watch, or their clocks set to their home so they can call home or check on the kids or just have a sense of comfort, but that actually worsens jet lag.
Street food can be a lot of fun. In some place it’s very safe to engage in street food. Singapore, for example, is known for safe street food. Other places, such as Africa, you probably want to avoid street food.
These are vendors that are selling food off the street. The hygiene is a bit questionable and more importantly, the water source may be questionable. So, it depends where you go. If you tend to go to a certain destination frequently and you know a vendor that you’ve been to many times, then that’s your judgment, of course. You don’t want to miss out on a lot of the fun and flavor of street food. But you just want to exercise caution.
Have a look at the vendor. This is where internet searches, such as TripAdvisor can be very helpful. This is also where the CDC website www.cdc.gov can be very helpful to know what is endemic in that area and what there is more of a current risk of in that area. So, enjoy street food with caution and don’t be afraid to ask questions about the source of the water. If you’re buying a beverage, make sure that the seal is intact. Always using bottled water is important. In some places, the bottle may be refilled, so make sure the seal is intact. Picking a bottle of water up from a street vendor, that’s one of the things you want to look at.
When in doubt, go with bottled water. If you’re not sure, you can always ask. It also depends on where you’re staying. If you’re backpacking, you want to be prepared with bottled water. You can also filter the water and use tablets to filter the water and make it safe if you’re backpacking. You can always ask. In upper-end hotels or restaurants, it’s perfectly acceptable to ask. You may ask for your drink with no ice because it may be made from tap water instead of bottled water.
Brushing your teeth isn’t as risky as actually swallowing the water. But we do swallow a little bit of water when we brush our teeth. It’s best to use the bottled water. So be prepared and have bottled water with you. Don’t forget about grocery stores as an option to buy your bottled water. When you get to your destination, one of the first things you want to do is look around and see where there’s a grocery store where you can buy bottled water. Keep it in the hotel and use that.
There are three Scripps travel medicine clinics in San Diego County. There is one at Scripps Coastal Medical Center Hillcrest, which is where I work. There’s one at Scripps Clinic Carmel Valley and there’s one at Scripps Coastal Medical Center Vista. They’re widely located throughout the county.
I tell my patients, make your appointment about three months out, but no later than one month.
The most important thing I tell my patients is, ‘Enjoy your trip and the better prepared you are, the more you will enjoy it.' Engage your doctor in helping you. It’s a lot of fun for us to talk to our patients about something fun and not just disease. We can help you. Even if you’re not sure if we can help you, we’ll be happy to give you all the resources that we can and write a letter if we need to. Go where you want to go. Go where your heart takes you.