Ask Gadling: You develop a serious illness while traveling

serious illness while travelingThe 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]

serious illness while traveling

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.
serious illness while traveling
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.
serious illness while traveling
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.
serious illness while traveling
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.
serious illness while traveling
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]

Going on a trip? Stop and get a flu shot at the airport

Luggage? Check. Passport? Check. Flu shot? If you’ve yet to get yours, you can take care of the task on the way to your next flight at clinics set up in several airports around the US.

Among the nearly 20 airports that will be offering flu shots beginning within the next few weeks are Atlanta, Boston Logan, O’Hare, Denver, Honolulu, LAX, JFK, and San Francisco. Costs range from $20 to $35, which is about what you’d pay at most clinics, unless your insurance covers it. Hours vary by location, but all are open from at least 8am to 4pm on weekdays. Currently, airport locations are only offering the regular seasonal flu vaccine. The H1N1 flu vaccine may be offered at these locations when it becomes available.

I’ll confess: I have never gotten a flu shot. I try my best to avoid being poked with a needle so the thought of actually requesting it seems counter-intuitive. I know I should get it though. 200,000 people were hospitalized for the flu last year, and travelers like myself who spend a lot of time breathing recycled air in the close quarters of planes may be at an increased risk. There’s also this little thing you may have heard of, called the H1N1 “swine” flu, which the CDC expects will reach pandemic proportions. It just makes sense to get the vaccine. And now getting a flu shot won’t even require a special trip to my doctor. I’m out of excuses. I may have to muster up some courage at the airport bar first, but it looks like my next vacation will start off with a flu shot.

Check out full details on airport clinic hours and costs here.

Attorney in 2007 tuberculosis plane scare sues CDC

It has been quite some time since we last heard from Andrew Speaker – the attorney who boarded a plane in Prague knowing that he was infected with a particularly nasty strain of tuberculosis.

Thankfully, the whole incident could have been worse, and only Mr. Speaker himself was infected.

Now he has made a full recovery, he is thanking everyone who helped keep him alive! going to sue the CDC.

See, Mr. Speaker is really annoyed that so much of his private medical information was “leaked” to the press. He is demanding ” unspecified damages and court fees” (which is usually code for a ton of cash).

According to Mr. Speaker, the stress of the incident caused him and his new bride to split up, and is causing him “grave mental anguish”.

Well, duh.

Let’s recap what Mr. Speaker did – he knew he was infected with TB, and despite warnings from doctors, he boarded a plane to Europe, then boarded another plane taking him back home. But despite knowing he could potentially harm others, he thought he’d be smart and fly to Montreal and drive to the border, as to prevent being stopped by border officials. In total, he took 7 commercial flights, and could have infected over 1000 people.

So, instead of moving on with his life, and feeling any regret for what he did – he’s going to sue the people who did everything they could to keep him and everyone he was in contact with safe.

Passengers protest peanuts, prefer pretzels

Blame Northwest. Or, blame the merger with Delta. Either way, peanuts are back, and some passengers are pissed.

On February 1, Northwest began dishing out peanuts on flights, which Delta has been doing since dirt was new. The timing isn’t all that hot, given a national salmonella outbreak involving Peanut Corporation of America. And then there are the people who are allergic to peanuts … they’re also far from thrilled with the change.

A commenter on the Star Tribune website (local to Minneapolis, where NWA is headquartered) wrote, “Northwest is really out of touch with its customers and the reality of allergies to peanuts.” Another chimed in, “What’s wrong with pretzels?”

Indeed, what is wrong with pretzels?

According to the Centers for Disease Control and Prevention, more than 3 million people in the United States are allergic to peanuts (or tree nuts). Food allergies cause 30,000 cases of anaphylaxis, 2,000 hospitalizations and 150 deaths every year. On its own, this sucks. On a plane, it’s worse than sitting next to a fat person.

Delta is doing what it can to prevent an in-flight disaster, creating a “buffer zone” of three rows in front of and behind a peanut-allergic person’s seat. And, the airline is advising “cabin service to board additional nonpeanut snacks.” So, flight attendants who are busy with such trivial matters as keeping order on the plane and tending to broader safety issues will have to keep track of the “peanut zone,” as well.

[Via CNN]

What strange things have been found on planes?


CBS Pilot Alert – Drama at the CDC

Will Smith & Jada PinkettMmm… Where do I begin with this one – the facts or my own personal opinion? I’ll start with the facts as I stumbled upon over at EURweb. The celeb powerhouse couple Will Smith and Jada Pinkett Smith, have had a few things up their sleeve since last July when Jada hinted at a new project she had been pitching to networks with her hubby Will Smith at the Television Critics Association Press Conference in Pasadena. In order to keep the project from being jinxed she declined to elaborate, but now the word is out and spreading like Mad Cow, Avian Flu and a bad batch of spinach. According to EUR: “It’s been confirmed that CBS has given a put pilot commitment to the project, which hails from CBS Paramount Network TV and Will Smith’s Overbrook Entertainment.” The untitled drama (Jada’s creation) will follow doctors at the Center for Disease Control, who fight viruses that threaten people globally.

Time for my two cents! Personally, I think it sounds fascinating and I can’t wait to see who they’ll cast for our virus fighting Docs, but it frightens me at the same time. I can just imagine episode #18 where a young couple comes back from a backpacking vacation in China and one falls ill with the world’s deadliest case of Avian Flu. Or episode #43 where a group of missionaries at an orphanage in Namibia contract Malaria after being given the wrong prescription back in the states… The scenarios are endless and while the CDC isn’t just about travel and disease, I tend only to scope it out when I’m heading somewhere far, foreign, and possibly flooded by disease. I’d hope none of the episodes sway anyone from traveling abroad, but let’s face it – people suck that stuff in. Someone out there isn’t going to want to go travel and explore ‘X’ destination because of ‘X’ disease related drama seen on primetime television. It happens. Television warps the mind, but I am very interested in seeing this when it debuts.

So with all that being said has something you ever seen on the tube (news or movies) ever kept you or changed your mind about traveling someplace? If so, give me the full details and just so it’s fair I’ll share a secret of my own. When I saw Boys Don’t Cry with Hilary Swank it made me never wish to go to Nebraska. Not that I’m a woman posing as a man, but it sort of gave me this negative idea that people aren’t nice there.

That’s my story what’s yours?