Central  South  Dakota  Medical News
The Clinical View
by Phillip E. Hoffsten
21 July 2004

MEDICAL TRAVEL TIPS

     It was 11:30 pm and I was trying to get to sleep.  The phone rang and it was a gentleman calling me from Minneapolis stating that his blood pressure was 170/100 and what should he do.  It seems that he had been taking medications to control his blood pressure for an extended period and it had been well controlled.  Earlier that day he had left Pierre and flown to Minneapolis.  He did not have a headache and there were no other symptoms than the blood pressure being elevated.

     This is a very common event in people that travel.  Traveling is a blood pressure raising activity.  This is true even for people with normal blood pressures.  There is something about not knowing where the bathrooms and the light switches are that makes people’s blood pressures go up.  For people that have high blood pressure to begin with even when it is controlled on medication, blood pressures will often go up when people travel.  I advised him to double up on his medication by taking an extra dose that night.  On his return to Pierre several days later, he acknowledged that his blood pressure was now back in the normal range and he was feeling well.

      Another common problem that develops in people that travel is fluid retention.  This is especially true in people that have heart problems.  Many people take water pills to control ankle swelling and the associated shortness of breath that can come with that.  Travel very commonly is associated with sitting on an airplane or in a car for long periods of time.  Fluid tends to puddle in the ankles and a 3-5 lb weight gain in several days time is relatively common.  I warn patients with heart problems that if they are going to travel, they may need to take extra water pills and be a little more conscious than usual about restricting fluid intake.

     Traveling either on business or vacation is usually not thought of in medical terms.  The person is more conscious about not forgetting clothing items or personal items, remembering airplane tickets, etc.  But a sobering thought is that 1 in 20 international travelers will encounter some disability during their trip.  This number obviously is increased for those that are older and have illness of one sort or another.  So planning medically for a trip, especially an international trip is very important.

     The following check list may be some help in planning travel:

     1.  If you are going to take medications with you, be sure that they are in individual bottles and labeled with the name of the drug.  There are reports that unidentified pills found in your baggage will be confiscated by baggage inspectors if the pills are not labeled as to what they are.

     2.  Perhaps the most common problem encountered in travel situations is diarrhea.  There are several medications that can help prevent this or treat it once it occurs.  In my opinion, the most effective is Pepto Bismol, carried as the tablet form so it won’t spill. Taking 2 or 3 tablets a day can be preventive for traveler’s diarrhea.  Alternatively, using 2 tablets four times a day will stop traveler’s diarrhea once it starts.  Imodium is an over-the-counter medication, as is Pepto Bismol, that can be taken to help control diarrhea.  When traveling to a foreign country where water is not reliably pure, carrying an antibiotic may be some help.

     3.  Immunizations for the prevention of malaria or yellow fever or cholera, etc. etc. are a very individual consideration depending upon which country a person is going to travel to.  Consulting your local physician regarding what immunizations are necessary and how far in advance is important.  Some require some several weeks of preparation prior to travel.  An up to date source for necessary immunizations is www.CDC.gov

     4.  One of the most common travel disasters is the excessive sunburn that can come at that tropical paradise.  The use of a sunscreen in appropriate amounts is very important.  A sunscreen rating of 30-45 SPF is usually protective even for those day long outings to the beach or tourist trips.  Reapplications at the beach are going to be required.

     5.  Motion sickness, sea sickness, air sickness and car sickness are not as common as they used to be with the smoother modes of transportation that we have today.  However, they do still occur.  If one is prone to this kind of problem, the use of products such as meclizine or Benadryl prior to travel can be helpful in preventing the motion sickness problem.  They both cause drowsiness which is something that you don’t need when you are trying to stay alert enough to travel and not forget things.  Scopolamine patches are another way to prevent the motion sickness and do not cause as much drowsiness but anxiety/restlessness may be a side effect.

     6.  If you are traveling with a baby, be sure to keep the bottle in the baby’s mouth during takeoff and landing.  This is important in preventing ear pain in babies.  The so called “Eustachian tube dysfunction” prevents equalization of the pressure between the ear and the nose.  This can be prevented in adults with the use of a product called Afrin nasal spray taken about an hour prior to travel on an airplane.  If a person has a sinus infection or a chronic upper respiratory track problem, Afrin nasal spray can be the agent that saves your trip.

     7.  One of the most common major problems that occurs on an airplane is an acute asthmatic attack.  For those individuals who have asthmatic problems, keeping the metered dose inhalers available is an important step.  If a person is having problems with unstable asthma, airline travel is not recommended.

     8.  Individuals who have chronic lung disease and need for oxygen can travel on an airplane.  However, a 48 hour advance warning to the airline is required so that oxygen can be provided on the airplane.  You are not allowed to take your own oxygen tank onto the airplane.  The airline company must provide that for you but they need to have a 48 hour advance warning with a written prescription for oxygen if it is to be used on the airplane.
 Questions are often raised to whether or a not a person with chronic lung disease can fly.  A simple test to determine the ability to fly comfortably is to have the person climb about 12 steps.  If they can do this without major difficulty, they are probably able to fly without major problems even if they use oxygen on a chronic basis.  The pressure on the inside of the cabin of a standard airliner is equivalent to the air at 8000 feet elevation.  The oxygen content of this air is only 80% of the oxygen content of air at sea level.  Discussion with your healthcare provider about oxygen needs while traveling can prevent big disappointments when you arrive at the airport unprepared.

     9.  Individuals who travel with a need for a wheelchair can be accommodated on a commercial airplane.  Again this requires advanced notification of at least 48 hours prior to travel so that the airline company can be prepared.  Electric motorized wheelchairs can be transported although the batteries that run these will have to be removed and deactivated during the flight.  This is to prevent the acid in the battery from boiling over at the lower pressure in the cargo section of the airplane.

     I recently attended a continuing education program sponsored by the Federal Aviation Administration.  This was in order to perform flight physicals for pilots.  A number that surprised me was the number of airline passengers there are in the United States every year. There are only about 280 million Americans but there are 600 million air travelers every year in the United States.  On the average, Americans travel on an airplane more than twice a year.  The safety record for airlines is amazingly good.  Per mile traveled and the number of people doing it, airlines are much safer than your automobile.