Top five things to look for in a travel doctor, and why you should have one

travel doctorsDespite writing about food and adventure travel for a living, I used to be somewhat blasé about the concept of travel medicine. Multiple incidents of Giardia/dysentery/traveler’s diarrhea/full-body outbreaks of mosquito and sand fly bites just taught me to carry a serious stash of antibiotics in my first-aid kit. At least I’ve always been conscientious about travel immunizations and educating myself about the primary diseases indigenous to my destination.

When you’re young and healthy, it seems silly to have a travel medicine specialist. Although this article is primarily directed at adventure travelers, odds are, the worst thing you’ll come home with is a backpack full of crappy souvenirs. But no one’s invincible, and should you require a specialist for something not responding to conventional treatment or with progressive symptoms, time is of the essence. Many “exotic” diseases progress rapidly, and can cause irreversible damage or death if not properly diagnosed and treated. Even with incurable diseases, the earlier you catch them, the easier it will be to manage symptoms and prevent them for worsening.

No, I’m not a doctor, although I come from a medical family. But I got seriously schooled after visiting Ecuador two years ago. After a fantastic month of adventure activities in remote parts of the Andes and Amazon Basin, I fell seriously ill the last day my trip. Two years of at-times crippling symptoms, 10 CT scans, five medical facilities, dozens of specialists, four surgical procedures, two surgeries, one cancer diagnosis, and near-medical bankruptcy later, I’ve become an expert at being my own advocate.

My infectious disease doctor believes that I contracted a form of bartonellosis called Oroya Fever after being bitten by sand flies. The good news: My health is currently stable, but we don’t know if the disease is in remission or not. But I have permanent cognitive damage, scarring or tumors on most of my internal organs, and intermittent arthritis. But believe me, I feel lucky.

I don’t want anyone to go through the health and medical nightmare I’ve endured, so I’ve compiled a list of essentials in a travel medicine doctor. Ergo, number one with a bullet:

1. Is he/she a travel or tropical medicine specialist?
Pre-bartonella, I used an internist as my GP/prescriber of antibiotics. If you can find an internist, gastroenterologist, or infectious disease doctor who is also a specialist in travel medicine, that’s a huge plus.travel doctors 2. Does he/she have personal experience traveling or practicing in developing nations?
There are a lot of practicioners who aren’t globally aware, so to speak. You can’t diagnose what you don’t understand, know about, or have first-hand experience with. Period.

3. Is he/she a good listener and empathetic?
It’s difficult to find these qualities in any doctor, especially in today’s medical climate. But it’s imperative to find someone you can communicate with, and who understands what you’re going through if you’re suffering from a mystery travel ailment. Don’t settle, even if you need to travel to another state or country to seek treatment (what stumps doctors here is often commonplace in the country of origin).

4. Does he/she have a good network of colleagues in multiple specialties (including travel/tropical medicine) to consult for additional opinions?
My current mantra is to seek a third opinion, from at least two different medical facilities. That, and to have a travel physician who actively consults colleagues and does additional research to assist with a diagnosis and/or treatment. My infectious disease doctor talked to specialists at a medical school in Peru on my behalf, and even tracked down a relevant medical paper from 1897 as he honed in on a diagnosis. And while I wouldn’t consider it a deal-breaker if the answer is no, see if your doctor is an active and participating member of the International Society of Travel Medicine.
travel doctors
5. Does he/she return your calls/provide you with email, pager, or office number so you can get in touch directly?
I’ve learned that a good doctor who is invested in your recovery will provide an open line of contact to address questions, concerns, and exchange pertinent information. Tip: Please don’t abuse this privilege. Physicians work insanely long hours, under constant stress. And don’t expect to hear back immediately if you leave a non-urgent message; be realistic. A couple of days, fine (many specialists aren’t in clinic every day). A week? Make a polite follow-up.

Whether or not you end up getting a travel doctor, the International Association for Medical Assistance to Travelers (IAMAT) provides loads of useful information, including a directory of global travel medicine clinics with English-speaking staff, and a destination-specific travel health planner. And depending upon what you plan to do on your trip, where you’re traveling, and your financial situation, you may want to invest in travel insurance.

[Photo credits: blood transfusion, Flickr user CarynNL;patient, Flickr user kk+; legs, Laurel Miller]

The Ultimate Travel First Aid Kit

Himalayan High: dangers of the trek

Over the past few weeks I’ve shared all kinds of thoughts on an Everest Base Camp trek, one of the best long distance hikes anywhere in the world. I’ve also shared my thoughts on the best ways to prepare for the trek and which gear items you should bring along with you to the Himalaya. In this, the final article in the Himalayan High series, I’ll share some thoughts on the potential dangers of the trek.

Beyond a shadow of a doubt, the biggest danger that anyone trekking in the Himalaya will face is the altitude. It is the great equalizer when it comes to determining success or failure on a high mountain trek, and even the most physically gifted and prepared hikers can be laid low by the thin air. Common symptoms that are brought on by altitude include headaches, dizzy spells, nausea, shortness of breath, and a loss of appetite. More serious signs of AMS, or Acute Mountain Sickness, include lethargy, sometimes to an extreme level, an inability to sleep, and vomiting.

Most of the members of my trekking group experienced at least one of those symptoms to some degree or another. Nearly everyone reported headaches and nausea of varying degrees, with a few experiencing serious issues. Of our 12 person group, two were unable to complete the trek to Base Camp. One of those suffered considerable nausea and was lacking in strength, so he elected to go down of his own accord. The other, had a full on case of AMS, and was lethargic to the point of not being able to stay awake. She was slurring her words considerably and was physically ill to the point where she couldn’t keep any food down. It became so serious that she had to be carried down the mountain by our porters, and would eventually recover at a lower altitude.
As for myself, for the most part I suffered few problems from the altitude. I would often start the day with a slight headache and feeling a bit hung over, but once we hit the trail, I would soon shake off the sluggishness altogether. Unfortunately, I did suffer one side effect that has troubled me in the past – the inability to sleep well at altitude. I’d go to bed each night exhausted from the long day on the trail, and almost without fail, I’d wake up in an hour or two later, and be wide awake for most of the rest of the night. It was rather frustrating, especially over a 12 day hike.

Unfortunately, there isn’t a whole lot you can do about altitude. It is nearly impossible to prepare for unless you already live in the mountains, and as I said, it effects everyone differently. The best advice I can give is to make sure you’re proceeding up the trail at a slow, measured pace, and take the acclimatization process very seriously. Also, ask your doctor for a prescription of Diamox before you go. It is a drug that is very popular with mountaineers and helps ward off many of the effects of altitude sickness.

One ailment that was difficult to avoid is the dreaded Khumbu Cough. It is a dry, sometimes painful, hack that practically everyone hiking in the region contracts. The cough is a result of the extremely dry air and cold temperatures, causing an irritation of the bronchi in the lungs and seems to be exasperated by high levels of exertion. Everyone in my group, without exception, suffered the Khumbu Cough to some degree, including myself. But in an odd twist, my cough wasn’t so bad while I was actually in Nepal, but managed to somehow get worse after I came home. Avoiding the cough is not easy, but wearing a mask or covering your mouth and nose with a Buff, can help limit the damage.

The next most common problem that most travelers in the region experience is gastrointestinal issues, most often brought on by the food or water. Trekkers will generally eat each evening in the teahouses that they are staying at, and while the food doesn’t taste half bad, it has the potential to be problematic for exhausted hikers who are already dealing with all kinds of other conditions. The fact that all food items, and pretty much everything else for that matter, has to be carried up the mountain by porters, gives it ample opportunity to spoil, especially items that easily perishable such as meats and cheeses.

Like many places in the world, the water can be a challenge to deal with as well. You can fill your water bottles for free in most teahouses, but you’ll want to treat it with water purification tablets or use a filter of some kind before drinking it. If you don’t, you’re likely to suffer terrible GI issues, which isn’t a fun thing to experience when you’re out on a trail for hours at a time.

Fortunately, I was once again spared any GI issues, but other members of the group were not so lucky. Some suffered from travelers diarrhea, and were frequently looking for a private rock to serve as shelter while they heeded the frequent calls of nature. Others had outright food poisoning, getting sick from the food in general. My advice is to stick to basic foods and avoid anything exotic. You’ll also want to avoid meats and cheeses when ever possible, especially as you go higher.

As on any hike, you do run the risk of physical injury while trekking the Khumbu. There are plenty of places on the trail where you can slip and fall, damaging more than just your pride. Twisted ankles and knees are a real possibility, especially considering that some portions of the trail are make-shift stairs carved out of rock. After climbing up those stairs for a couple of hours, your tired legs are more likely to cause a stumble, and while there were a few such incidences in my group, no one was seriously injured.

One other common concern for travelers heading to Nepal is a potential chance encounter with the Maoist Rebels that are known to inhabit the countryside and remain active there, despite the fact that they won control of the government a few years back in democratic elections. In the past, those rebels were known to shake down trekkers for money and occasionally kidnap them as well. But those days are behind us, and visitors can now roam the countryside with out too much fear. They were seldom an issue on the road to Everest to begin with, and on my trek there was little sign of them outside of a few propaganda posters.

Like any trip to remote region of the world, there are always inherent dangers. But the amazing scenery, friendly people, and wonderful culture make this journey one that is well worth taking. Despite suffering issues from altitude, exhaustion, and an extremely nasty cough, I still enjoyed every minute of my adventure in the Himalaya, and suspect that any adventurous traveler would feel the same.