Featured in the May Issue of Northwest Arkansas Citiscapes
by Chris Hardin, MD, FACP, Internal Medicine, MANA Fayetteville Diagnostic Clinic
With summer approaching, I see several patients planning vacations both domestic and abroad. A visit for travel medicine advice and vaccinations if needed is not uncommon. A patient’s needs when traveling can vary based upon his/her own personal circumstances and the destination.
- For those traveling abroad, I will frequently consult the Center for Disease Control for more specific recommendations. It’s best to remember that is always flu season somewhere around the globe, and there are international travelers in every airport. Patients should make sure to be up to speed on their own vaccinations for influenza, pneumonia, diphtheria, pertussis, and tetanus. In addition, it’s not a bad idea to travel with a small bottle of alcohol based hand gel. For travel abroad, a hepatitis A vaccine is a common recommendation. This is a food borne illness that can be preventable with a simple vaccine which is given as two injections and should be given as soon a foreign travel is considered.
- In addition, some air travelers may need specific notes from their doctors; to carry supplemental oxygen or needles for insulin injections, for example. Keep an up to date list of your current medications as well with generic names. The brand names may vary from country to country but the generic name is practically universal. I recommend that all of my patients login to their online patient portal, myMANA. An online healthcare record is private but very portable, a nice resource to have should you become ill while traveling.
- A certain amount of preparedness goes a long way. When vacationing, thinking about protection from the sun is a must. People of all skin types should wear sunscreen. The American Academy of Dermatology recommends a water resistant sunscreen of SPF 30 or greater that protects against UVA and UVB rays. Also, I would recommend a long sleeve shirt and wide-brimmed hat, both of lightweight fabric. Adults and children should wear sunglasses when outdoors as well. The ultraviolet rays can have adverse effects upon the retina as well as the skin. Occasionally, I will prescribe scopolamine patches to patients with a tendency toward motion sickness. These are applied just behind the ear prior to travel and help prevent or lessen some of those symptoms. Less commonly, I will prescribe an antibiotic if my patient is traveling to an area where there may be a higher likelihood of developing gastroenteritis. In general, doctors have tried to be stingier with antibiotic prescriptions given the rise of over utilization and subsequent emergence of resistant bacteria.
- With every time zone that a traveler passes, the likelihood of having jet lag goes up. This may cause some difficulties with sleep, low energy, and difficulties with concentration. It’s a good practice to stay up until it is dark in your destination and adhere to the mealtimes of the new time zone. In addition, staying properly hydrated and exercise will help. If needed, over the counter melatonin can safely help with sleep issues caused by jet lag. Melatonin is a naturally occurring hormone from the pineal gland in the brain. The supplement however may interfere with other medications such as blood thinners and anti-seizure meds, so patients should consult with their doctor, nurse, or pharmacist before adding this.
- Zika virus. Now that I have your attention, we’ll talk about malaria. Both are transmitted by mosquitos. If traveling to a tropical or subtropical area where malaria is endemic , I would recommend a DEET containing insect repellant (also helps to prevent tick bites if traveling throughout Arkansas). There are also some very nice permethrin-impregnated clothes that help prevent insect bites. In addition, an anti-malarial prophylaxis may be prescribed by your physician based upon the latest CDC guidelines.
- As far as Zika goes, guidelines are ever evolving as we understand this disease. This mosquito-borne virus can range from a relatively asymptomatic illness to fever, joint pain, rash, and conjunctivitis. A primary concern is the sexual transmission of this disease and the deleterious effects upon a pregnancy. For known infection, a male who returns from an area where Zika is endemic should consider abstaining from sex or use of condoms for six months. For those without symptoms, consider these recommendations for eight weeks. I’m sure these recommendations will continue to change as we further understand the duration of shedding of this virus.
- As for health insurance, patients should touch base with their carriers prior to international travel. Most will cover for urgent or emergent needs while traveling, but it’s best to consult with individual insurers to make sure there are no gaps in coverage. Also, some health insurance will cover for a doctor’s visit for the purposes of travel health advice. However, some do not, considering it to be elective and a non-covered service.
- Most importantly, cardiovascular health is a must. An upcoming vacation can be a great motivator to stay in good shape. Travelers may have the goal of exploring a national park or walking the sidewalks of a foreign city. Following the American Heart Association guidelines, every adult should have some moderate intensity activity such as a brisk walk at least five days per week.
Have fun and safe travels!
Dr. Chris Hardin is an Internal Medicine physician at MANA Fayetteville Diagnostic Clinic. He provides primary care for adults and young adults age 15+.