Ask Gadling: You develop a serious illness while traveling

by Laurel Miller on

The very thought of acquiring a serious illness or injury while traveling strikes fear into the hearts of even the most stalwart adventurers. Speaking from personal experience, it’s terrifying to find yourself alone (or not) in dodgy accomodations, in a remote area of a developing country, with a raging fever and/or an uncontrollable case of the runs or other unsavory symptoms. Which isn’t to say the same ailments suffered in the comfort of a five-star hotel in Paris are a picnic, either. Any way you slice it, getting sick in a foreign country sucks.

And sometimes, despite taking precautions, you fall ill anyway, as I can attest. It can be a matter of circumstance (That water my guide “boiled” in a bamboo culm on a Thai Hilltribe trek? Yeah, I pretty much saw the resulting case of dysentery coming), or just bad luck. I’ve been on my own during most of my unfortunate on-the-road maladies. Between my experiences and those of fellow travelers, I’ve accumulated some wisdom over the years for dealing with sudden-onset illness in less-than-ideal circumstances.

For the purposes of this article, I’m not going to include injuries, pre-existing conditions, or focus on food poisoning, which was well-covered in a previous Ask Gadling post by Melanie. I also want to stress that we’re not medical professionals here at Gadling, myself included. For the technical stuff, I turned to Dr. John Szumowski, Clinical Fellow of University of Washington Medical Center’s Division of Allergy and Infectious Disease.

After the jump, tips on prevention, what to do when illness strikes, and how to get yourself home in the event of a full-blown medical emergency.

[Photo credit: Flickr user MoHotta18]

Before you leave home

Hit the internet
Do a bit of research on emergency medical options for a worst-case scenario. The U.S. Department of State produces a list of American doctors and hospitals in foreign countries.

If you have specific questions (about, say, where to find the best dentists in Europe), Lonely Planet’s Thorn Tree travel forum can be a useful place to get ideas (please do additional research before following any advice). Take the diagnostic-related questions directed to forum members with a heaping grain of salt, and save them for your doctor.

Get vaccinated
Check the CDC’s (Centers for Disease Control and Prevention) website to see what, if any, vaccinations you need before your trip. You can also get updates on things like outbreaks of cholera or bird flu. Be sure you allow ample time before your trip for the protective effects of vaccines to establish themselves. Dr. Szumowski also recommends the CDC’s “Survival Guide to Safe and Healthy Travel” webpage.

View more Ask Gadling: Travel Advice from an Expert or send your question to ask [at] gadling [dot] com.

Keep an immunization card on you (some countries require proof of certain vaccinations) as well as an online record, like Google Health.

All travelers should get flu and tetanus shots. If you’re a frequent world traveler, get vaccinated for hepatitis A, typhoid, and polio. Depending upon where you’re traveling, you may require a Yellow Fever or Japanese Encephalitis vaccine, or malaria prophylaxis.

I used to think a rabies vaccination was overkill until I saw a fellow traveler get seriously nipped by a puppy we were playing with in a remote village near the Myanmar border. The deathly silence that followed was sufficient motivation. Adds Dr. Szumowski, “It’s still important to remember that excellent wound-care and post-bite medical evaluation are necessary, even if a person has had prior rabies pre-exposure vaccination.” The International Society of Travel Medicine has a list of global travel medicine clinics.

I also carry an EpiPen, because you never know what could trigger anaphylaxis while you’re abroad. It also bears mentioning that you can develop a life-threatening allergy to something previously benign. A chef I know went into anaphylactic shock after tasting one of his dishes containing taro root, even though he’d been cooking with it for over 20 years.

If you get sick

Stay calm, and assess your symtoms
It’s easy to get carried away and assume the worst, but odds are your sudden fever isn’t malaria.

Try to identify the source of infection or illness

Know when to seek professional medical assistance
In general, says Dr. Szumowski, some symptoms or exposures that should prompt “expeditious” medical evaluation include:

  • high fevers (over 101ºF, especially if sustained or accompanied by shaking or drenching sweats)
  • bloody diarrhea
  • inability to keep food or liquids down in situation of significant vomiting or diarrhea
  • confusion or severe headache
  • severe cough, especially if accompanied by shortness of breath
  • animal bite or other animal-related attack

Tips for self-care

Stay hydrated
If you’re vomiting or have diarrhea, stay hydrated with (purified/bottled water), and Gatorade or other electrolyte beverages. If you absolutely have to travel, take Imodium as an anti-diarrheal.

Eat bland foods
Remember the BRAT diet for gastrointestinal upset: rice, bananas, applesauce, and toast.

Control your fever
To lower a high fever, take the recommended dosages of acetaminophen (Tylenol) or ibuprofen (Advil).

Wear ID
Wear a medical alert bracelet for serious conditions, allergies, etc., Write down your condition in your destination country’s language in both your phrasebook, and place a card in your passport.

Emergency Measures

Know when to self-diagnose
Sometimes, you find yourself in a position where you have no other option. That said, this is something you want to avoid for obvious reasons. Says Dr. Szumowski, “Self-diagnosis and treatment can be appropriate for less serious conditions such as traveler’s diarrhea, but it is important not to delay evaluation by a medical professional for more serious illness [see warning signs above]. If someone chooses to self-treat, it’s important to be aware of potential for counterfeit medications locally.”

What if the only available hospital/clinic/doctor’s office is seriously sketchy?
If you’re in a situation where the medical facility is primitive/lacking in sanitation, you’ve got a tough call on your hands.

I posed this question to Dr. Szumowski. He says, “It depends on the acuity and seriousness of the condition. In general, evaluation and treatment in a facility with adequately-trained staff and more comprehensive resources is preferable whenever possible–this may mean seeking evaluation in the capital, at a private hospital, or even returning home. Aside from limited diagnostics and medications, smaller/less-resourced facilities may have inadequate sanitary practices (e.g. reuse of equipment) and screening of blood products, raising the risk of contracting pathogens such as hepatitis C or HIV. Therefore, having evacuation insurance is advisable, especially for extended travels in the developing world.”

In other words, you may be shit out of luck. But this is why you’re reading this article–so you can be prepared for all kinds of situations! Read on.

OTC antibiotics
In many countries, you can buy OTC antibiotics, and indeed, this may be your only option, but heed Dr. Szumowski’s warning, above. Caveat emptor.

If you need to be evacuated, the U.S. government offers financial assistance and/or repatriation loans. The American Citizens Service and Crisis Management (ACS) is linked to U.S. embassies and consulates all over the globe. It’s a good idea to enroll in the U.S. Department of State’s “Smart Traveler Enrollment Program (formerly known as “Traveler Registration)” if you’re traveling for a long period of time, to a high-risk region, or doing any extreme adventure activities.

Travel prepared

Get antibiotic prescriptions (and carry copies with you) from your primary care doctor or internist, or visit a travel medicine clinic, and pack them in you travel first-aid kit (You don’t have one? REI has some great options). Some people also carry sterile latex gloves and hypodermic needles with them. If you’re diabetic or have another condition that requires injections, this makes sense, provided you have a note from your medical provider. For everyone else, this is a personal choice that comes down to, “How comfortable are you with the knowledge that you’re carrying drug paraphernalia?” If you backpack, travel in places with notoriously corrupt law enforcement, or countries like, say, Malaysia, you may want to hedge your bets.

Email yourself and family or a trusted friend copies of medical insurance, itinerary, and a list of medications, and doctors.

Consider traveler’s insurance.

If the worst happens

In the highly unlikely event you do come home with a mystery disease that isn’t responding to medical treatment, get to a specialist, asap. Depending upon where you’ve been, this may be an infectious disease or tropical medicine doctor, a dermatologist or rheumatologist who specializes in tropical medicine, etc.. You may need to travel–out of state–to find the right specialist. Find someone who has first-hand experience traveling/training or practicing in developing countries, and in diagnosing diseases not found in the U.S.. It may even be best to try and seek medical treatment in the country where you became ill (even if that means a return trip).

Unfortunately, I can speak with authority this subject, because I’m in my 22nd month of diagnostics following a trip to South America. If you do find yourself harboring a travel-related (or not) disease that defies diagnosis, you must be your own advocate. No one is more invested in your health than you are, and doctors are human. They may make mistakes, despite their best intentions. Seek not just a second, but a third opinion, from at least two different medical facilities.

And finally, don’t let anything in this article scare you and put you off travel. Odds are, you’ll come home with nothing more than great memories, and the eagerness to plan your next trip. I know I can’t wait.

[Photo credits: vaccination, Flickr user alvi2047; mosquito, Flickr user tonrulkens; toast, Flickr user snowriderguy; farmacia, Flickr user ibirque; drugs, Flickr user cavale]

Is Iraq really safe to visit?

by Aaron Hotfelder on


If you ever visit Iraq, it’s probably best to tell your parents about the trip after you return. That’s what my friend Jennifer Martin did, and she says it saved her parents from lots of (mostly) needless worry.

Jennifer has just returned from a week-long tour of Kurdistan, a semi-autonomous, surprisingly safe region of northern Iraq. (Venture further afield than Kurdistan and you’re asking for trouble.) While most people would balk at visiting an area of the world virtually synonymous with war, Jennifer did some research about Kurdistan’s security situation and decided to go for it, a decision which guarantees her an automatic victory in just about any travel-related pissing match.

I recently asked her a couple questions about visiting northern Iraq– whether it’s really safe to visit, what are some of the region’s highlights, and how locals reacted upon meeting her. Here’s what she had to say…

1. Most people would never dream of visiting Iraq because of concerns about their safety. How did you decide to visit the region of Kurdistan and, perhaps more importantly, how did you know it would be safe?I was deciding where I should visit during a week-long break from school, and my ideas consisted of Portugal, Spain, and Tunisia. The problem was that I couldn’t justify spending money on arbitrarily picking a destination included on every Euro-backpacker’s “must-see” list. I e-mailed my well-traveled friend for advice, and he responded, “Come with my friend and me to Iraqi Kurdistan.” My initial reaction was not to thoughts of danger; rather, I immediately asked myself, “What do I really know about Iraq other than the information circulated by the media?” I was surprised by how much I knew about its ancient history and how little I knew about its recent history. Thus, I started to learn and decided to live by the phrase, “Instead of asking ‘why,’ ask ‘why not’.”

Well, I didn’t know it would be safe. Just like I don’t know that it will be safe walking to my car after a late-night baseball game in the States. Aside from the fact that Iraqi Kurdistan has maintained relative peace for several years now, the additional reasons I believed Iraqi Kurdistan was (is) safe for travel are twofold. First, I scrolled through several travel blogs of people who visited Iraqi Kurdistan as well as recent news in the area to ensure that all was calm. Secondly, the media and the news greatly exaggerate conditions in a country. Travel advisories for Vienna, one of the safest cities in the world, warn of kidnappings. Even in my hometown of St. Louis, travel warnings mention the risk of a massive earthquake. It’s ridiculous. If we listened to the media, we’d never leave our homes. If you do your homework and be responsible, the chances of danger are greatly reduced.

2. What are some attractions and activities in northern Iraq that travelers might be interested in?

Because travelers to Iraqi Kurdistan receive a 10-day travel pass, there is not a lengthy amount of time to see the region unless an extended visa is obtained. Generally, public parks and large bazaars can be found at the center of each city, and the landscape of the Kurdistan countryside is incredible.

Over the course of our travels, we visited the cities of Dohuk, Amadiya, Erbil, Sulaymaniyah, and Halabja. Erbil is home to one of the oldest bazaars and to the Citadel, arguably the oldest continually inhabited place in the world. From Dohuk, day trips to Amadiya, Lalish, and Gali Ali Beg Canyon are possible. Located approximately 30km outside of Dohuk, Lalish is the sacred city of the Yazidi faith. Amadiya, approximately 60 km from Dohuk, is a small village built on a plateau and situated amongst mountains. Traveling to Gali Ali Beg Canyon is somewhat more difficult, but it is one of the most scenic places in Iraq.

The most impressive sight on our trip came in Sulaymaniyah at Amna Suraka, the headquarters of the Iraqi Intelligence Service during Saddam’s regime. This prison operated as a facility for the imprisonment, torture, and death of thousands of Kurds. It has been maintained in its condition since the 1991 uprising by the Kurdish Peshmerga: tanks border the courtyard, bullet holes coat the walls and blankets still lie on the ground in the cells.

Additionally in Sulamaniyah, travelers can visit the Slemani Museum, which holds artifacts from 15,000 BC. A short distance from Sulay is Halabja, the city known as the place where the Ba’ath party dropped chemical weapons on the Kurdish residential areas, killing over 5,000. A museum located before the city’s entrance commemorates this event, and within the city, one can find the Halabja cemetery.

There are other activities and sights to where travelers can visit by looking through travel blogs and performing independent research.

3. Did you meet many (or any) fellow travelers during your time in Kurdistan? How were your experiences with the locals while you were there?

We only encountered one other traveler, a nice Canadian guy named Sean. We first met him while crossing the Turkish-Iraqi border and again while at the Citadel in Erbil. It was an enjoyable and unique experience being the only tourists for the majority of the time. Often people looked at us in a friendly-but-curious manner.

The locals were some of the friendliest people that I’ve encountered. They were welcoming, willing and eager to help with any of our questions, and happy to speak with us. If someone couldn’t speak English, he or she would use hand gestures to make “small talk” or to explain a point. Further, we put 100% of our trust in the shared taxi system and in the locals for help in navigating our way around the region. It was never necessary to haggle for a price, and we were never swindled.

Lastly, my friends and I always felt safe. While traveling between cities, we would encounter numerous checkpoints; however, they were never a hassle. Even several of the Iraqi Kurdistan military members at these checkpoints were noticeably friendly and expressed joy upon seeing that American tourists were visiting their country.

4. Any advice for someone considering a trip to Kurdistan? Would you recommend it as an off-the-beaten-path travel destination?

First, check out the latest travel blogs, websites, and message boards. Fortunately, many travelers have provided detailed accounts of their trips on the internet which serve as great guides on places to see, what to expect, and how to travel in the region.

Without a doubt, I would recommend Iraqi Kurdistan as a destination for travelers who don’t mind keeping their plans very flexible and who can go with the flow. The locals are wonderful, the sights are incredible, and the learning opportunities are numerous.

Thanks so much for chatting with us about your trip, Jennifer! For more, check out Jennifer’s blog for five excellent, photo–filled posts about her visit to Iraq.

[Photos courtesy of Jennifer Martin]

Ten reasons I thought I had malaria symptoms (but I didn’t)

by Annie Scott on

Sometimes, fear of the worst gets the best of you. That’s what happened to me last week when, having recently traveled to Zambia, I thought I had malaria symptoms. Am I crazy? No. Am I usually a hypochondriac? Not at all — but that’s partially due to the fact that I almost never get sick. As a matter of fact, that’s the issue behind #3.

Ten reasons I thought I had malaria symptoms (but I didn’t)

1. I had been in Zambia.

Pre traveling to Zambia, I went to the doctor to get shots for Hepatitis A and Typhoid (that one hurts like a jerkstore), as well as prescriptions for Cipro and Malarone — a malaria prevention medication. Every travel document I received warned me and rewarned me that I was visiting a “malaria zone,” and I definitely came home with a fair few mosquito bites.

2. I missed a pill. Maybe more.

You have to start taking Malarone a couple days in advance of travel, then take one at the same time every day until seven days after you get back. The pill, like most pills, is not 100 percent effective even if you get it right, but I didn’t get it right. One night, I forgot to take my pill until after dinner (I’d been taking it at 6 and took it at 10), and after I got back, I completely forgot to take one on a Saturday. I read my instructions and they said to just skip it and take the next one at my normal time.

And what? And pray?

3. I got a cold.

Most people wouldn’t think twice about getting a cold, but I am one of those lucky folks who almost never (knock on wood) gets sick. When I developed a fuzzy head and a cough about ten days after getting back, I couldn’t help but think, just in the back of my mind: “Do I have malaria?”

4. I Googled.

As anyone with a computer would, I googled the symptoms for malaria. Our friends at WebMD (I know) informed me that the incubation period could be anywhere from nine days to ten months. Great. Symptoms:

  • Fever.
  • Chills.
  • Headache.
  • Sweats.
  • Fatigue.
  • Nausea and vomiting.
  • Dry (nonproductive) cough.
  • Muscle and/or back pain.
  • Enlarged spleen.

I wasn’t vomiting, didn’t know where my spleen was and hadn’t taken my temperature, but the rest was definitely going on. An even less heartening statement followed: “Symptoms may appear in cycles and may come and go at different intensities and for different lengths of time. But, especially at the beginning of the illness, the symptoms may not follow this typical pattern.”

Great.

5. I slept a ton.

I’m a good sleeper and all, but even after my cold symptoms started to diminish, I was suddenly sleeping like 10 hours per night, and feeling sleepy during the day. Does this happen to everyone now and then? Yes. But it was happening to me, Potential Malaria Victim Annie.

7. I felt “different.”

Perhaps it was psychosomatic, but I couldn’t help feeling that something was wrong. I was probably just still getting over the cold (and coping with the side effects of Nyquil), but I didn’t feel “normal.” I was sleepy, as I mentioned, and woozy and had no energy. This continued until a week after the cold hit. I wasn’t even getting as much work done as I should have been. At this point, I wasn’t sure I had malaria symptoms, but I was keeping an eye on it.

6. I had sudden, outrageous bathroom hell.

I’d been feeling nauseous all day. It had been my husband’s birthday the night before, so I attributed it to being out late, but suddenly, at 3:30 PM on a Tuesday afternoon, I was in the bathroom vomiting. It happened once, then again, and I still wasn’t feeling better. I sent an email cancelling my plans for the night, then was back in the bathroom. By an hour later, I had called my husband at work, sobbing and begging him to come home for fear I was going to pass out and choke on my own vomit. I was really sick. And, as the vomiting had finally come, I was pretty sure I had malaria.

8. I couldn’t move.

Unlike with the flu, during which you get a few minutes of glorious “I feel okay” time after you throw up, I was completely incapacitated. I spent twenty minutes just sitting on the bathroom floor with my cat looking at me pensively. When I finally made it into bed, the phone rang and I couldn’t look to see who it was, because even turning on my side made me dizzy and out of breath. I was obviously suffering from a violent strain of malaria, and probably near death. I lay paralyzed, worrying about my spleen.

9. I had a fever.

My husband came home terrified and immediately gauged that I had a fever (and kindly brought me Cheerios and a bucket). That was it. The final nail in my coffin. Even if I got better, I would have this strain of malaria for the rest of my life, however short that might be.

10. I’m an idiot.

My husband said “I’ve never seen you this sick!” … and that triggered me to think of the last time I’d been so sick. I couldn’t think of any instance, any precedent at all until … oh wait … that time I got food poisoning in London and threw up the second I got to Glasgow for about 18 hours straight. As I ate Cheerios one by one, about an hour later, my fever was gone. Shortly after that, I was eating Cheerios by handfuls.

At last, a far less dizzy me ventured into the restroom and had bathroom hell … the other way. I stepped out concerned that though I felt a little better, I was clearly still sick. My husband smiled and said “Honey, I think you’re in the final stages of food poisoning.”

Oh.

Whoops.

So, after a harrowing food poisoning experience and a completely harmless cold, about two days later, I felt completely fine — and I have felt fine ever since. I write this not just to overshare, but to confess, and to assure you that if you’ve ever convinced yourself you have a possibly fatal disease after traveling, you’re not crazy.

Or, you know, we’re both crazy.

[Photo by James Jordan via Flickr.]

Five tips to reduce your health risk while eating street food

by Laurel Miller on

It was the 18th century food writer and gastronome Jean Anthelme Brillat-Savarin who famously said, “Tell me what you eat, and I’ll tell you what you are.” For certain cultures, street food is more than just a cheap, tasty, easy way to fuel the body. It’s part of a daily ritual, a way to catch up on neighborhood or community gossip, a means of eking out a living to provide for one’s family. By eating foreign street food, you get a sense of the social fabric and gender roles of a community or culture, but what about the health risks?

Some travelers equate a love of street food with a latent wish to sightsee whilst wearing an adult diaper. They steer clear of anything sold from a vendor, or resembling fruit, vegetable, or beverage not from a bottle (although when it comes to drinking water, you should always err on the side of caution, and there is something to be said about peeling or washing produce to avoid pesticide residue, since many developing nations use chemicals banned in the U.S.). What these folks may not realize is that foodborne illnesses such as E.coli, salmonella, and listeria don’t discriminate. FDA statistics show you’re more likely to get sick from preparing food at home than from dining in a domestic restaurant.

Is street food inherently more risky than eating in a restaurant when you travel? Sometimes, and it depends. Children, the elderly, and those with compromised immune systems are certainly more at risk of getting ill, and may be best off avoiding street eats. But there are certain precautionary measures healthy travelers can take before scarfing their tacos or mystery-meat kebabs that will minimize the chances of bringing home more than just a suitcase full of sweatshop-made tchotchkes as souvenirs. Read on.

1. Is there a crowd? Just like at home, go where the locals go, as they obviously know where to find the good stuff. But high volume also means that food is being prepared fresh, rather than sitting around attracting flies and turning into something useful for waging biological warfare.

2. Are basic hygiene practices being implemented by the vendor(s)? In Mexico, I’ve frequently observed street vendors slipping clean plastic bags over plates. With every order, a new bag is used, then discarded at the end of the meal. It’s an eco-nightmare, but it’s a lot more sanitary than dunking a plate in a bucket of dingy water doubling as a petri dish. Also bear in mind that in many parts of the world, the left hand performs double-duty as toilet paper. I can’t say it enough: Look at the sanitation practices before ordering.

You’ll often find co-workers whose sole responsibility is to handle money, to avoid cross-contaminating food (this isn’t always the case, however, so sometimes you’ll just have to–literally–suck it up). Once, when I accidentally handed my money to the wrong guy, he turned his hand upside-down to avoid contact with my filthy coins.

3. Is the stand or cart clean and well-maintained? Is hot food kept hot or cooked to order, and is cold food cold? Is purified water or ice used for beverages and frozen treats?

4. Are the ingredients fresh? If you’ve got eyes, a nose, and some tastebuds, you can figure this out for yourself. I look at the condiments and garnishes to determine if I want to eat at a given stand or cart. If I see crusty bowls of salsa, dessicated limes, slimy herbs, or flies congregated on any raw foods I might potentially eat, I’m out of there.

Stick to local specialties. One of the greatest joys of travel is eating regional ingredients or dishes. It also stands to reason that ordering seafood in an inland desert is a calculated risk. Raw protein products (egg, meat, poultry, fish, fresh cheeses) in general are to be avoided in the Third World. What about dishes like ceviche, where the acid in the citrus juice denatures (breaks down proteins, killing some potential pathogens in the process) the fish? It’s still risky, because technically it’s an uncooked food, and only application of heat over 145 degrees can totally annihilate anything potentially deadly lurking in fish. Again, use good judgment based on freshness of ingredients and basic sanitation, but remember that you can’t eliminate all risk.

If you’re in a coastal region, it pays to do a bit of homework on the cleanliness of the local fresh and ocean water supplies; algae blooms or cholera outbreaks will be widely reported. Try to avoid eating raw river fish or seafood, or river fish/seafood from just offshore; remember that many developing island nations and coastal regions use high tide as their toilet. If you’re eating pork in the Third World, always make sure it’s well-cooked. While trichinosis has effectively been eradicated from our domestic industrial pork supply, the disease is prevalent in other parts of the world. And not to get too graphic, but you’ll often find pigs in rural parts of the developing world lurking around latrines, searching for a snack.

Fresh ingredients don’t necessarily mean great food, but it helps. Delicious street food is ulimately a reflection of the loving care that goes into its preparation. Are the carnitas slightly crispy on the outside, with an interior succulent with greasy goodness? Is the masa in the tamales moist, with a sweet, earthy corn flavor? Are the noodles slightly toothsome, the herbs fresh and bright-tasting, the broth fragrant and piping hot? These things matter.

5. Use hand sanitizer before eating, take probiotics with live active cultures prophylactically, and pack a broad-spectrum gastrointestinal antibiotic and Imodium, just in case. I’m just sayin’.

For more information on food safety, go to this page on the USDA website.

Five conflicting British skin care tips for winter

by Tom Johansmeyer on

Okay, spend less time in the shower … but keep your skin moist. And, stay dry. It’s confusing stuff, right? Well, we’re all used to getting conflicting advice, from employers to religious authorities. So, how do you use it? The best way is to pick and choose what’s most convenient, I’ve found, and just accept the consequences when they (inevitably) come.

Well, winter is around the corner – you’ve probably noticed the air getting a little crisper. It’s always a good idea to think ahead, especially if you want to protect your skin from the cruel cold in the coming weeks and months. I stumbled across the following tips in The Sun, and if you can make sense of them, you’ll be all set when the cold wind starts to blow.

1. Manage your temperature: this shouldn’t be too hard, you know, in winter. Make the inside more like the outside by keeping the heat down. Apparently, this will keep your skin from drying out. If you start to shiver, put on a sweater (or sweatshirt … or smoking jacket).2. Stay stinky: if you smell, you’re doing well. Spend less time in the shower, and don’t allow yourself to enjoy the decadence of hot water. Of course, athletes and laborers can shower as much as they want, along with anyone else who sweats like a pig. The Sun suggests: “shower or bathe every other day and spot-wash trouble-spots such as armpits, hands, feet and face.”

3. But, make sure you stay wet: and this is where the fun begins. Keep the temperature down to stay moist (1), and avoid water by not showering (2). Now, The Sun says, “Keep skin moist.” Check this out:

Try Vaseline Intensive Care’s DermaCare lotion (£2.79 for 200ml). Boots’ skincare adviser Steve Barton says: “Slather it on after a bath or shower, preferably before your skin has dried out entirely, so it can trap moisture in.”

4. Wear protection: if you work with detergents a lot (e.g., dishwasher), you again want to avoid the stuff. Throw on some gloves.

5. Keep the water inside you … and stay dry on the outside: it’s important to stay hydrated. So, even though you want to be moist and dry at the same time, don’t forget to put some fluids inside you. On the outside, particularly your clothing, do your best to keep the water away.

[photo by joshjanssen via Flickr]