WAYS TO PREVENT BEING SEASICK AND OTHER TRAVEL MEDICAL TIPS

Whether you are traveling by sea or by land, there are many things you can do to prevent medical problems. Here are some of them.

MOTION SICKNESS

If you’re sailing where the sea may be rough or if you are concerned about motion sickness in any situation, take along some ginger capsules, ginger tea bags or ginger cookies. Ginger works wonders against nausea. If the sea gets rough and you start feeling rocky, head for the deck and fresh air and keep your eyes on the horizon. Don’t read or write postcards or do anything that focusses your attention downward. Eat some ginger cookies or take ginger in any form, or eat some dry crackers. Vitamin B6 has been found by some people to be a good preventive against nausea (you can buy it in any health food store). Some people find help from an acupressure wrist band that presses against the nei kuan pressure point at the wrist (be sure to position it correctly). One aromatherapy oil applied to the temples is also claimed to be of benefit.
If you know that the weather is going to be rough or if you are prone to motion sickness, get a prescription from your doctor before a trip for a Transderm patch to wear behind your ear, or take a Bonine or Dramamine or similar pill early, before you get sick, because it takes a while to take effect. If rough weather is expected, the ship usually makes Dramamine tablets available. (If you take Dramamine or Bonine be aware of the fact that it will likely cause drowsiness.) If you are prone to being seasick, then you can make your journey more comfortable if you choose a cruise that features calmer waters, such as on a river or along a sheltered coast instead of the open sea. You can take a cruise up the US intracoastal waterway or cruise the Mississippi or Ohio Rivers or glide by castles on the Rhine, go up the Amazon, the Orinoco, or the Nile.
Ships with deep heavy keels usually are more stable than ships with shallow drafts. It also helps to choose a cabin on mid-level decks and toward the middle of the ship where there is less motion. The bow of the ship gets the most motion.

SEE IF YOU NEED SHOTS BEFORE YOU GO

If you are going to any remote areas, check with your Public Health Department on whether you need any pills or immunizations. Do this a month or so ahead, because some pills need to be taken ahead of time. They can also tell you of any epidemics in the areas you will be visiting so you can take proper precautions. For example, if your cruise includes a visit to certain parts of Africa you may need a yellow fever and cholera vaccination certificate.
To learn what is currently recommended you can also consult the Center for Disease Control (www.cdc.gov), Travel Health Online (www.tripprep.com) and the International Society of Travel Medicine (www.istm.org).
Major problems you may need to be protected against:
+ Malaria. Prevalent in Haiti, the Dominican Republic, Central America, and parts of Mexico, South America and Asia.
+ Dengue Fever. It is spread by mosquitoes and is found frequently in the Caribbean, Central and South America and southeast Asia.
+ Typhoid. Fleas, lice and ticks spread this disease, and it is especially active in Mexico, Peru, Pakistan and India.
+ Polio. India has thousands of cases diagnosed every year, and it is also active in Mexico.
+ AIDS. It is everywhere, and some primitive areas have extremely high rates. Do nothing to get exposed, including saying no to transfusion with blood or blood products in a medical emergency.

WHAT TO TAKE

If you regularly take a prescription medicine for a chronic problem, be sure to pack enough (in your carry-on bag, not a checked bag) because it is difficult to have a prescription filled in a different country. Leave medications in their original bottles to avoid problems at customs.
If you plan to travel on your own after a cruise, consider taking a first-aid kit. And even on the cruise it’s a good idea to have sunscreen, burn medication, insect repellent, bandaids, hydrogen peroxide, pain and fever medication, antacids, a topical antibiotic, medicines for diarrhea and constipation and some vitamin C or herbal formulas in case a cold starts coming on.
Carry your health documents with you that tell what immunizations you have had or any other medical information that you think is important. You need proof of immunizations at certain ports of call. Keep the paper with your passport.
If your trip is going to be strenuous, start getting yourself in shape ahead of time. It’s a long walk up narrow stairs to photograph the gargoyles of Notre Dame, it takes 250 steps to reach the threshold of the Great Wall of China and the most exciting rain forest hikes could last several hours.
Does your medical insurance cover you when you are out of the country? If not, you might want to add a rider to your insurance policy, or if you travel a lot, to switch to a policy that covers you anywhere. You can buy separate medical insurance specifically for a trip or by the year.
And speaking of insurance, if you are in your last three months of pregnancy, most doctors recommend that you do not go far away or on a cruise.

HOW TO LESSEN JET LAG

Jet lag occurs when you travel quickly across several time zones. At the destination you feel tired and washed out, your brain is foggy, your reactions slow. (Because of differences in their body clocks, young people have a harder time flying from west to east, and older people have a harder time going from east to west.)
There are several things you can do to lessen the effects. Before you leave home, pretend the time is that of the time zone where you will be going and gradually adjust the hours when you eat and sleep to what they will be at your destination. On the plane drink plenty of fluids to prevent dehydration, don’t smoke or drink alcohol or much caffeine, all of which make it harder to adjust. If you can spare the time, get to your destination a day or two early to allow your body to adjust. When you get to your destination, if it is daylight, go outside even if you are tired and take a walk. Exercise and sunshine both help set your body clock to the new schedule. Some research indicates that vitamin B12 taken daily for two weeks before the trip may enhance the response to light and also ease the change. Melatonin has also been found helpful; check with your doctor if you want to use it.

TRAVEL FATIGUE

Have a long wait for a plane? Some hotels have day rates which gives you a chance to stretch out and relax. At the destination port, cruise lines often have a hotel room reserved as a hospitality suite where you can go to relax before boarding time.
If you have hypoglycemia or even if you don’t, drinking lots of water and eating protein snacks every few hours will help you fatigue and irritability.

SAFETY

On a Ship
Slipping, tripping and falling are the major sources of shipboard injury. Try not to stub your toe or trip over the raised threshold in the doorway. (By the end of the cruise, you will be used to them and will probably step up when you go into your bathroom at home). Wear sensible shoes on deck (those with rubber soles, not flipflops, not heels). Wear flat shoes if the ship is rolling in a rough sea.
Don’t throw cigarettes over the side or clean your pipe by banging it on the side or the railing. Burning tobacco could blow back on board in someone’s face or could start a fire. Don’t light a candle in your cabin.
Use doorknobs and handles, not the sides of doors, so a sudden lurch won’t catch your hands in the door. If the weather is rough or you’re on the tender, keep one hand for holding on as you move about. Be extra careful when decks are wet.
Pay attention at the lifeboat drill. Note various routes from your cabin to deck, and notice lighting along corridors to aid in following exit pathways in case of fire.
Take your time going down the gangway or getting in and out of a tender. Don’t be pressured or rushed just because there are other people waiting. Never get your hands, arms or legs between a tender and the ship where a wave can crush them together. If a person offers you help getting in and out of a tender or a zodiac, don’t take their hand, instead use the forearm-to-forearm grip which is more secure. If you don’t know it, get someone to show you.

In the Water

If you go swimming, snorkeling or diving, watch for strong currents or undertows. Stay in areas you have been told are safe. Swim and dive with a buddy and look out for each other. Never put your hand in a dark hole. Don’t pet a shark. If you’re going to snorkel or swim off the boat, tell a crew member.
Things to watch out for: bristle worms, scorpion fish, moray eels, fire coral (yellow or browning with stinging white tentacles, but don’t touch any coral - it kills it), sting rays (shuffle your feet as you go), sharks (but nurse sharks and silkies are usually docile unless provoked), and barracuda (don’t wear jewelry in the water).

On Shore

At the beach consider wearing dive socks or other protective footwear to help protect against sea urchins, glass or sharp coral or rocks.
In ports drink only bottled water and avoid salads, uncooked foods and foods that have likely been uncovered a long time. Eat only fruit you can peel.
Don’t sit under the coconut tree. You will notice that very few locals are seen standing under coconut palms. There’s a reason. Lounge somewhere else -- the head you save may be your own.
Wash your hands frequently, or use disposable towelettes. Be careful about swimming in streams, rivers or lakes. Some nasty diseases or parasites may be in even the cleanest looking fresh water. Even trailing your hands in the water can expose you to serious problems. Special places may have special problems. If you are in areas of pigeon droppings in Turkey, cover your mouth with a scarf to help ward off histoplasmosis. In Africa and remote parts of Central and South America where mosquitoes can spread malaria and dengue fever, use insect repellent on clothing and use mosquito netting when recommended.

LOOK OUT FOR THE SUN

Sensitive to the sun? Many people are helped by taking a capsule of PABA (para-aminobenzoic acid) before exposure or try Solatene, a pill containing beta-carotene. Both are available without prescription. Studies also suggest that eating lots of yellow and green vegetables high in beta-carotene is helpful to building natural protection. Also be aware that certain substances can increase sun sensitivity, such as lime juice, juice of figs, fennel, dill, parsley or celery, thiazide pills, many oral diabetes drugs, some tranquilizers, some antibiotics, griseofulvin used to treat fungal infections, oil of bergamot in many cosmetics and perfumes, most artificial sweeteners and chemicals in some deodorant soaps.
You may not be bothered by sunburn at home, but on a cruise you need to be careful, even if the sky is overcast. Remember that the water reflects the sun’s rays so you are getting more intense exposure. If you are near the equator the rays are more direct and stronger than in temperate zones. If you snorkel, you may feel cool in the water, but your back, neck and legs may be getting dangerous exposure. You may not feel you’re being burned until it is too late. Exposure can also be a problem on shore if you go to high altitudes. Don’t forget your sunblock and wear a hat if you’re out in the sun. Be especially careful when swimming and snorkeling or where the sun’s rays are intensely hot or in the Antarctic where there is a hole in the ozone layer.

AWAY-FROM-HOME FIRST AID TRICKS

If you are stung by a jellyfish, get out of the water so you will not have more contact, drench the tentacles clinging to your skin with sand, salt or flour, what ever you can get your hands on quickly. Scrape off or wipe off with a towel. To stop the stinging action, apply alcohol or whiskey or any lotion containing alcohol. To neutralize the poison, soak the area with ammonia or fresh urine. Back at the ship, you can apply calamine lotion, corticosteroid ointment or antihistamine cream, or if rash is severe, take an antihistamine pill. Prevention: stay out of the water when you see jellyfish and do not disturb man-of-war floats on the beach.
If you come in contact with fire coral, apply alcohol or other antiseptic cream and antihistamine cream. Prevention: don’t touch coral.
Sting ray wounds: These can be very serious. Remove the sheath if you can see it, then the wound should be rinsed out with a syringe repeatedly with salt water, and ammonia or urine applied. Immerse the wound in hot water to help relieve pain. If there is difficulty in breathing, swelling or dizziness you may be having an allergic reaction and should get immediate medical care. Prevention: wear shoes when wading and shuffle feet on sandy bottoms. Don’t handle rays.
You forgot some after-sunburn spray? Apply one or more of these to the sunburn: cold wet towels, cucumber slices, vinegar, cold tea, vitamin E, or jelly from an aloe plant. To lessen pain while in your bunk, sprinkle baby powder on sheets to reduce friction. Drink plenty of water to counteract dehydration.

SWIMMER’S EAR

If you’re in the water a lot you may be a candidate for Swimmers' Ear. After swimming or showering, water normally should run out of the ear, and the ear dries naturally. However, if water remains in the ear, it provides a breeding ground for bacteria and fungi. The result: "swimmer's ear", sometimes called "jungle ear" by those who roam humid lands instead of waters.
According to the American Academy of Otolaryngology- Head and Neck Surgery, the symptoms are an itching, swollen ear canal and pain. The Academy recommends the following: Put your head over to one side with the affected ear up. Pull the ear up and back and squeeze a few drops of rubbing alcohol into the ear canal (alcohol dries out the ear and kills bacteria and fungi). Wiggle your ear to move the solution all the way into the ear, then tilt your head over to the affected side to let the solution drain out.
Note: Do not do this if you are prone to infections or if you have ever had a hole in your eardrum.

IF THERE IS A MEDICAL EMERGENCY

What if there is a medical emergency? Ships that go out to sea usually have a physician on board, and those that are near the coastline can get you to a port that has medical facilities. If necessary, the ship can have you airlifted by helicopter and flown to the nearest medical facility. Personal Physicians Worldwide has a list of doctors worldwide so that if you become ill in a foreign country they can determine the nearest appropriate medical facility (888-657-8114).
If you use the services of the ship’s physician there may be a charge for it.

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