Travel Medicine

A small proportion of travellers suffer from acute mountain sickness or altitude sickness. Altitude sickness can occur at altitudes above 2500m. Altitude sickness can be mild and cause headaches, lethargy and tiredness to more severe which includes altered conscious state requiring emergency medical treatment. Anyone at any altitude can be affected – even experienced mountain climbers.

Prevention is the key. A gradual and slow ascent allows your body to acclimatise. It is optimal to spend some days below 2400m before ascending higher. Having a rest day every 1000m is important. Drink plenty of water and avoid alcohol and sedatives. If you experience any symptoms – tell someone. It is important to rest at this altitude for an extra day or more, or descend if more severe symptoms occur. Prophylactic medications may be helpful. Please speak to your doctor.

Clean drinking water is vital to stay hydrated and avoid gastrointestinal symptoms such as diarrhoea. For most people, purchasing bottled water with an intact seal is sufficient. Other ways to treat water can include prolonged boiling, chemical disinfections and using portable filters.

A DVT is a blood clot that forms in the deep leg veins. It may travel around the body (ie embolise) and cause damage to vital organs, such as the lungs. Long periods of immobility such as on a flight or long bus trip can increase your risk.  Reducing your risk of DVT is important. This includes drinking plenty of fluids like water, avoiding diuretics like alcohol and caffeine, regularly moving around the cabin and also doing calf exercises.  Some people like to wear compression stockings.

Some travellers are at higher risk. These include those with a past history of thrombosis. However, being overweight, pregnant, having a history of cancer or being on certain medications can also increase your likelihood. Your doctor will discuss recommendations specific for your needs.

Traveller’s diarrhoea is very common especially in developing countries. It can ruin your holiday and leave you bound to your hotel room. It is usually associated with ingestion of untreated water supplies, poorly prepared food or poor personal hygiene. Symptoms commonly include diarrhoea and crampy stomach pains and there may be nausea or vomiting.

There are a number of preventive and treatment strategies that are extremely effective. Diarrhoea can be prevented with vaccination, good personal hygiene and water filters if clean water supplies are not available. Recovery from gastroenteritis can be aided with oral rehydration solution, pain relief for crampy stomach pains and in some instances the need to take a course of antibiotics. Medication for nausea and vomiting can also be helpful to improve your intake of fluid. Please discuss your concerns in detail with your doctor.

Many older people enjoy travel. There are some specific things for older travellers to consider including;

• A complete medical examination prior to travel. This should include an assessment of your general fitness for a particular journey as well as a medication review.
• Be up to date on routine vaccinations, with particular attention to influenza and pneumonia vaccination.
• A doctor’s letter detailing a list of relevant medical conditions, a copy of a recent ECG, current generic medications, and allergies.
• Travel health insurance with pre-existing illness cover.
• Avoid excessive sun and strenuous activity, plan for frequent rests, access air-conditioned rooms, drink more fluids, and wear loose fitting clothing.
• Have a management plan in case of diarrhoea or constipation.
• Luggage with built in wheels may help alleviate back concerns.
• A spare pair of glasses and extra medications should be packed along with a relevant medical ‘first aid’ kit.

Jet Lag includes symptoms of fatigue, headache, sleep disturbance, altered eating patterns and reduced physical performance when our normal circadian rhythm is out of sync with the environment we are in. It is worse with long distance travel and when travelling east.  It can take several days to weeks to return to normal function.  The following are a few suggestions to minimise jet lag

• Stop over en route on long haul flights
• Travel west, during the day and aim to arrive late afternoon/early evening
• Stay on home time for the whole journey. On arrival, immediately adopt local time for eating and sleeping
• Exercise and exposure to light may help minimise symptoms
• Melatonin tablets are a popular but unproven therapy

Malaria is caused by a parasite, which is transmitted through the bite of an infected mosquito. It is found in tropical and subtropical climates. Symptoms typically include fever, rigors (uncontrollable shaking) headache, muscle and joint pains, nausea & vomiting. Some people might turn yellow (jaundiced) or experience breathing or gastrointestinal problems. Malaria can cause serious illness and possibly death if not treated promptly.

There is no vaccination against malaria however preventative measures are strongly advised to minimise your risk. This includes avoiding being bitten by, wearing clothes that cover skin including long sleeves and pants, sleeping under netting and by taking anti-malarial medications. Your doctor can discuss the suitable medications with you.

It is a good idea to take a medical kit when travelling. Planning ahead may go a long way in preventing illness. Your destination and your travel companions (ie children) may influence what you put in your kits. Basic kits should contain something to detect and treat fever, pain, cuts, scrapes and blisters.  It is also useful to pack insect repellent, mosquito nets, clothing impregnation kits, sunscreen as well as hydration solutions to manage diarrhoea. Travellers might also consider antibiotics to manage gastroenteritis, anti-malarials and medication for nausea and vomiting.

Travel is unlikely to be a problem for a healthy pregnant traveller. There are some considerations all pregnant women should regard. These should be discussed with your GP or obstetrician.

Travel is generally discouraged after 35 weeks gestation. The airline you are travelling with may impose its own limitation. They may request a letter from your GP or specialist. The duration of flight will also influence this. It is best to contact the airline directly for their policy. If you have a multiple pregnancy (twins, triplets etc) this will influence the advice you are given.

Avoid areas with malaria if possible. Ensure you have adequate travel health insurance for you and possibly your baby if born early. Reduce the risk of thrombosis (blood clots) ; see our section on DVT. Avoid live viral vaccines, such as Yellow Fever, Chickenpox and MMR during pregnancy. Discuss travel medications with a doctor. Avoid all non-urgent travel to Zika affected countries if pregnant.

An alarming number of travellers return home reporting unprotected sexual contact during business or holiday travel, especially with strangers. Abstinence is the only way to completely avoid all sexually transmissible infections such as HIV, hepatitis B, gonorrhoea, syphilis and chlamydia to name a few. However, we know that this is not necessarily practical. The next best thing is to practise safe sex. This includes using a condom at all times with a water-based lubricant in all sexual encounters. It’s not a bad idea to take condoms manufactured to Australian Standards with you. It is also a recommended to have a full sexual health screen should you have a new sexual partner when you return home.

Being prepared for your trip makes travelling with children more enjoyable. Children adapt well to change but the following tips might improve your holiday.

• Never leave children alone
• Immunisation- make sure these are up to date prior to travel including not only travel immunisations but also those on the national schedule
• Always carry fluid with you and a snack in a bag goes a long way if delays are encountered
• Have changes of clothing available appropriate for the weather
• Protect from insect bites; preparations of up to 30% DEET for skin, and permethrin impregnated external clothing and nets
• Medical Kit- include paracetamol or ibuprofen for fever and pain, sunscreen, dressings for bites/sores/cuts & grazes, Gastrolyte for rehydration, antihistamines for allergy and travel sickness
• Avoid excessive sun, plan for frequent rests, access air-conditioned rooms, and encourage your children to drink plenty of fluids
• Age appropriate entertainment including books, games and toys
• Minimise the number of bags you will carry. Being overloaded can make it difficult to look after children and can make you a target for thieves
• Be aware that child safety standards including pool safety, car seats and toys may not be as strict as in Australia. Supervision is paramount
• If your child takes regular medication ensure you have a medical review with your GP prior to your travel. Ensure you have adequate amounts of medication with you
• If your child suffers from anaphylaxis, have an up to date anaphylaxis plan and Epipen (if appropriate) with you. Ensure you are familiar with how to use it. Speak to your friendly GP at Royal Park Medical to review, if in doubt

Children travelling overseas are more prone to common problems such as trauma, respiratory, gastrointestinal and skin infections, sunburn and insect bites. However, two conditions deserving special mention with your doctor are diarrhoea and malaria.

Royal Park Medical stocks a range of travel vaccines which can be purchased through our clinic, for your convenience. Your GP will determine which vaccines are suitable and recommended for you during a consultation and in most cases, will be able to do arrange immunisation at the same time.

This information is intended to support, not replace, discussion with your doctor or healthcare professional. The authors have made considerable effort to ensure the information is accurate, up to date and easy to understand. Royal Park Medical accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen.