Travel Health Tips

In addition to vaccinating yourself against disease and illness before travelling overseas, we strongly recommend you read up on our foreign travel health tips to help better equip yourself in order to prevent the contraction of disease and/or illness while on holiday.

DVT is a condition where a clot forms, usually in your lower leg, but it can be in your thigh, pelvis region or even your abdomen.

This can stop the flow of blood in the area and potentially can become dislodged and move to your lungs, causing something called a pulmonary embolism or PE.

This can be a very serious and life threatening condition

Who gets a DVT?

Who is at risk? Certain factors make a DVT more likely to occur. They are more common in people aged over 40 and in people who are obese, or who have already had a DVT.

Other factors include:

  • Smokers
  • People with cardiovascular disease like CHF-congestive heart failure, a recent heart attack or stroke or recent surgery (in the last 3 months)
  • Those who are pregnant, especially in the last trimester, or who have had a baby in the last 6 weeks
  • Women that use birth control or contraceptive pills, hormone replacement therapy or tamoxifen post breast cancer
  • People who are currently being treated for cancer

Signs and symptoms

Unfortunately the symptoms can be silent. If there are symptoms they could include:

  • Pain at the site that is noticeable, or worse when standing or walking
  • Redness, swelling and warmth in the affected leg
  • There may be pitting oedema (your finger impression stays after pressing your finger on the leg) in the affected leg
  • If the clot was to dislodge and move towards the lungs, you may feel it is hard to breathe, or feel you need to breathe faster
  • There may be an increased heart rate
  • Dizziness or anxiety
  • A cough that produces pink or frothy fluid. This is serious - you would need to ask for help immediately

These are not always a sign of a deep vein thrombosis, but anyone who experiences them should contact a doctor immediately.

General Preventive Measures

  • Exercise the legs regularly
  • Maintain weight that is appropriate for you
  • Avoid sitting or lying for prolonged periods

Preventive Measures For Travellers

Although the added risk of developing a DVT caused by travelling is considered low, it can be reduced even further by exercising the legs at least once every hour during long-distance travel. For example taking regular driving breaks or walking up and down the aisles in planes or coaches.

The muscles of the lower leg can be exercised while sitting by pulling the toes towards the knees then relaxing, or by pressing the balls of the feet down while raising the heel.

Other Preventive Measures

  • Do not take sleeping pills
  • Drink plenty of water to preven dehydration and avoid alcohol and caffinated drinks
  • Wear loose-fitting clothing
  • Keep the legs uncrossed
  • If you have time in between flights, walk around at the airport.
  • Wear compression stockings, particularly for those at higher risk
  • Some Doctors recommend taking certain medications to help prevent DVT, however this should be discussed during your appointment at Travel-Bug or with your GP. For many people the above simple preventative tips may be all that is needed
  • Anyone who develops swelling or pain in the leg, or breathing problems after travel should seek medical advice urgently

Treating a DVT

Treatment aims to prevent:

  • The clot becoming larger
  • The blood clot breaking loose and travelling to the lungs
  • New clots from forming
  • Post-thrombotic syndrome

Medicines

  • The most common treatment is anticoagulant (blood thinning) medicines, which reduce the blood's tendency to clot. These are usually taken for three to six months. Regular blood tests are needed to check the levels of the drug in the blood.
  • These medicines can prevent new clots from forming and old clots from growing larger, but they do not dissolve the clot. The body will do this itself over time.

Compression Stockings

These are used to relieve pain and swelling, as well to prevent post thrombotic syndrome. They may need to be worn for several months.

Putting Your Feet Up

Most people with a DVT are advised to place a cushion under their feet while resting or sleeping, so that the feet are raised higher than the hips. This helps to reduce the pressure in the vein of the calves.

Further Information

Department of Health - www.doh.gov.uk/dvt

 

Precautions concerning food and drinking water will reduce your risk of contact with food and water borne diseases such as Hepatitis A, Typhoid, Cholera and traveller's diarrhoea.

Overseas travellers frequently suffer from gastric (stomach) upsets that are caused by viruses, bacteria and parasitic worms not found in Australia. These are transmitted by:

  • Improperly prepared foods
  • Untreated water
  • Poor personal hygiene

Food Precautions

  • Avoid pre-cooked and reheated foods
  • Avoid cold meats, salads, mayonnaise, seafood, milk and other dairy products
  • Eat only thick skinned fruits that you have peeled yourself
  • Ensure that you wash your hands with soap and water or hand sanitiser prior to eating or handling all food

Water Precautions

  • Use a water purifier or filtered water bottle (available at Travel Bug), they provide safe drinking water and are environmentally friendly
  • Alternatively and if possible, only drink bottled water. Make sure the bottle is properly sealed
  • Water that has been boiled for 10 minutes is best to ensure safe drinking water when bottled water is not available and can be used for brushing your teeth.
  • Water purification tablets should be used as directed
  • Canned/bottled drinks and drinks made with bottled water are safe
  • Avoid ice in your drinks as well as ice cream and ice-blocks

 

Gastric upsets can be identified by abdominal cramping, diarrhoea, fever, nausea or vomiting. If you experience more than six loose stools and/or have blood in the stool, seek medical advice immediately.

Treatment of these symptoms includes re-hydration and rest. Re-hydration using electrolyte hydrations solutions and diluted fruit juice are good but be sure to make preparations exactly as directed. Failure to re-hydrate can lead to further dehydration and possible hospitalisation.

Other medications, used per their directions, can assist in gastric issues should they arise. Medications to slow things down to allow for effective re-hydration plus antibiotics to treat ongoing difficulty are a good idea to have on hand.

If you are traveling to a destination with an altitude of over 2500m, you will be at risk of altitude sickness, pulmonary oedema or serious central nervous system disorder. These risks are negligible below 2500m, possible between 2500 and 3500m and likely over 3500m. There are no reliable predictors for individuals; potentially all travellers have the same risk. Previous tolerance of high altitudes is the only guide that is reliable. The cause of altitude sickness is a reduction in the air pressure around you (barometric pressure) which results in less oxygen molecule intake per breath.

 

Symptoms

  1. Headache, loss of appetite, nausea, insomnia, dizziness, swollen ankles, ataxia and apathy
  2. Shortness of breath, reduced exercise tolerance (usually these occur on the second day and indicate fluid building up in the lungs: this is a medical emergency)
  3. If untreated, the brain will swell, causing coma

 

Prevention

It is important to acclimatise. Above 2500m, ascend slowly. Limit each night's camp to 300m or less above the previous night's camp altitude. If you wake with symptoms in category 1 or 2, descend immediately, but not alone. Symptoms can progress rapidly and can be fatal. A decompression bag is often used when descent is not possible (usually with a foot pump - this effectively lowers the altitude by 1000m by increasing the oxygen levels). You should still descend after 1-2 hours in the bag.

 

What Can You Do To Improve Your Chances?

You can take medication to trick your body into breathing more quickly, hence 'acclimatising' the body in advance. This medication is called DIAMOX (Acetazolamide), is inexpensive and will give you an edge on your symptoms (they will occur at a higher altitude than otherwise). Remember, group tours ascend at a set rate, and not all people can cope with the same rate of ascent. Rest days are often incorporated into tours, but they are not really for rest, they are because the ascent rate has been too great. Be careful!

Diamox contains sulfur and a test dose is recommended prior to travel. These are available at our clinic free of charge and if you react to it you will be at our clinic, not on a mountain pass. Our specialists will explain how this works at your appointment.

NB: Do not fly into high altitude destinations and then start climbing (eg, Cusco). A few days of acclimatisation are essential. The tours actually insist on this, so they have become aware of the pitfalls.

 

How High Is It?

Any altitude can be acclimatised to, given enough time. After all, many have conquered Mt Everest which is 8,848 meters above sea level. To do this many weeks must be spent ascending and waiting for the body to adjust. Below are common destinations people currently go to which are above the limits the body can deal with if one just was to "fly in".

Cusco 3300m
La Paz 4200m
Base Camp Mt Everest 5200m
Mt Kilamanjaro 5400m
Lhasa 4200m
Lake Titicaca 3800m

Commonly people will have skied or climbed to quite high altitudes on a previous holiday. If you have not slept at altitude, you are not going to know if you will be ok.

Problems are very rare below 3000m.

Bites, stings and contact of some insects cause unpleasant reactions and some may transmit diseases. Mosquitos, ticks, black flies, sand flies, tsetse flies, fleas, mites and lice transmit disease.

  1. Apply insect repellent containing DEET (e.g. Repel, Bushmans) to exposed skin. Avoid eyelids, lips and damaged skin. Some insect repellents come combined with sunscreen - good for daytime protection
  2. Wear long sleeved clothing and long pants / dresses (light coloured) and socks
  3. Avoid going outside when mosquitoes are most active: between dusk and dawn
  4. Avoid perfumes and aftershaves as the aroma may attract some insects
  5. Close doors and windows at night or protect them with screens
  6. Spray inside room / house with aerosol insecticide (for flying insects) at dusk, after closing doors and windows
  7. Overhead fans or air conditioners are effective in hindering mosquitoes from landing
  8. Use a mosquito proof bed net (preferable impregnated with insecticide - eg. permethrin), with edges tucked under mattress. Ensure the net is not torn
  9. Treat clothes with insecticide eg permethrin
  10. Burn mosquito coils or mosquito mats
  11. Keep away from stagnant or standing water (mosquito breeding grounds)

Note: for ticks wear long clothing and socks and, put insect repellent on ankles under clothing

Mosquito borne diseases include: Malaria, Japanese Encephalitis, Rift Valley Fever, Dengue Fever (daytime mosquito) and Yellow Fever (daytime mosquito in Africa and South America only)

Various medications can be used to prevent malaria. Here is some information to help you in the complex process of deciding which drug is best for you.

Doxycycline

  • This medication will work in a large number of areas, and is one effective drug for the difficult Thai/Myanmar and Thai/Cambodia borders
  • Taken 1 tablet per day starting 2 days prior to entering a malarious area, every day while there and for 28 days after leaving the malarious area.
  • Contraindicated in pregnancy or if under 8 years of age.

 

Side Effects:

  • A small number of people are more prone to sunburn. If so, take the medication with your evening meal, rather than in the morning, apply sunscreen and avoid sun exposure.
  • Some women develop thrush so thrush cream (Canestan) can be taken just in case
  • Women should also be warned that it reduces the contraceptive effects of the pill for the first 2 weeks whilst taking it
  • Nausea and vomiting occur occasionally and can be reduced by combining medication with a meal, remaining upright after dosage, and drinking lots of water.

 

This preparation will cost slightly over $1 per tablet.

Promozio/Malarone

  • Appears to be very safe, effective and to have few side effects, but is expensive (about $7 - $8 per tablet).
  • Taken 1 tablet per day, starting 2 days prior to entering a malarious area, every day while there and for 7 days after leaving the malarious area.

 

Side effects

  • Almost none, but take after a meal to reduce any side effects (Gastrointestinal side effects are reported at higher doses used for treatment of malaria ie: 4 tabs/day for 3 days). Our clinic has this preparation available and because of the cost, can provide individual tablets.
  • You do not have to buy a whole box if it's not needed - they come in packs of 12.

Lariam

  • This drug is usually well tolerated and can be used for long term prevention.
  • Taken 1 tablet per week, starting 1-2 weeks prior to entering a malarious area, continuing during and for 4 weeks after leaving the malarious area.
  • To test the tolerability of Lariam, it is suggested the medication is commenced at least 3 weeks prior to departure. If side effects are not tolerated you have time to change to an alternative medication.
  • Contraindicated in epilepsy, depression, anxiety, psychotic illness.
  • Cautions: cardiac conduction defect, or if taking calcium channel or beta-blockers. Driving, diving and piloting may be difficult.

 

Side Effects

  • These have been exaggerated in the media, but include insomnia, nightmares, irritability, and depression. These can affect one in 200-500 in a disabling fashion. Psychosis does however occur in 1:12000. 2 Cases of psychosis have been reported in people taking it for the second time and the psychosis continued after cessation of the medication. This is disturbing information. However, 97% of travellers are able to tolerate the drug without discontinuing it
  • Alcohol, cannabis etc. may exacerbate side effects so are best avoided for 36 hours after a dose
  • The dose may be halved and taken every 4 days to help reduce side effects, and it is very important to take with a meal and to be well HYDRATED.

 

Cost about $8/tablet.

Pregnancy

Malaria increases the risk of adverse outcomes in pregnancy so should be avoided if at all possible.

Safe

  • Both Lariam and Chloroquine are considered safe in all stages of pregnancy

 

Unsafe

  • Doxycycline is not safe as it affects the teeth of babies and inhibits bone growth
  • Primaquine passes across the placenta so can cause haemolytic anaemia in a G6PD deficient foetus
  • Promozio/Malarone should be avoided in the first trimester. Your travel health consultant will discuss its use in the 2nd and 3rd trimester

 

Children

Children are easy targets for mosquitoes so should take medication.

Safe

  • Promozio and Lariam are safe to use for children. Dosages are determined by weight

 

Unsafe

  • Doxycycline is not suitable for children under the age of 8yrs as it can cause teeth staining

 

The same pre and post trip times apply to children and adults

Fever in a child in a malarious area should be taken very seriously as malaria can kill children very quickly.

 

Malaria Emergency Standby Treatment

Some malaria can be fatal within 72 hours if not treated. Your travel health consultant may discuss malaria emergency standby treatment options.

Remember, malaria should be considered if you have travelled to a malarial area within 12 months and you have a fever over 37.5?C with or without

  • Headache
  • fatigue
  • Body aches and pains
  • Gastrointestinal tract symptoms
  • Shivering

If these symptoms occur, and reliable medical attention is not available within 24 hours of onset of symptoms, and you have been in a malarious area for 6 days or more you should take your standby treatment. Immediately change your travel plans and find reliable medical services as soon as possible.

Many things need to be done well before you leave - and then of course there is packing!

We recommend you arrange your travel insurance as soon as you book flights and accommodation.

 

Get fit! At least you can start! (You should have done this anyway.)

 

4 months out

  • Obtain and begin reading materials regarding trip. Hikers, adventurers and even beach addicts will gain increased value and enjoyment from the holiday with a little more knowledge. Also, learn a few phrases of the native language.
  • Send passport and Visa applications off, they take forever!
  • Some countries require validity of passport for 6 months at time of entry, so check the expiry date NOW! Please note some Visas require a blank page (and some say 2 pages!) in your passport.

 

2 months out

  • Start vaccinations 6 to 8 weeks prior to departure. Also, sort out any special needs on the plane/s, e.g. oxygen and wheelchairs.
  • Discuss potential malaria risk with your travel health consultant
  • Ask your travel health consultant which medical kit they recommend (available at Travel Bug)

 

Toiletries

  • Any item deemed dangerous will be taken off you and you will never see it again, so consider this carefully.
  • Any liquid will also be relegated to the hold luggage or confiscated too. Remember: toothpaste is considered a liquid.
  • Shaver/ blades/ mirror (not in hand luggage)
  • Brush/Shampoo and conditioner/ soap
  • Toothbrush and toothpaste
  • Nail scissors/ tweezers (not in hand luggage)
  • Deodorant (aerosol not in hand luggage)
  • Toilet paper/ plastic bag for litter
  • Laundry detergent
  • Chap Stick/ lip balm
  • Clothes
  • Consider the extremes of temperature possibilities, and pack some things for unseasonable weather. Think about:
    • Scarves/ hat/ gloves/ jacket
    • Jeans/ shirts/ bathers/ sarong/ night garments/ underwear
    • Footwear/ thongs
  • On the plane you should wear comfortable clothing, no belt and shoes you can take off and put on easily (airport security methods are now very annoying!)

 

Accessories

  • Sunglasses/ sunscreen/ towel
  • Phone/ phone charger/ adapter
  • Camera/ film/ spare memory
  • Note book/ pen/ torch/ novel/ phrase book
  • CD/ MP3 player/ IPOD
  • Handkerchief/ tissues
  • Money belt
  • Pocket knife (not in hand luggage)
  • Alarm clock (if not taking phone)
  • Glasses (prescription)
  • Plastic Bags
  • Umbrella
  • Small sewing kit
  • Inflatable pillow
  • Travel games

 

Documents

  • Passport/Tickets/itinerary and vaccination book
  • Money (2 forms in case first fails you)
  • Insurance papers/ drivers licence/ photo ID
  • Travel agents phone number
  • Photocopies of all documents should be taken and a copy left at home, and posting on the internet is also a good idea!

 

Last Minute

  • Arrangements for pets, deliveries, keys, neighbours and itinerary copy to others
  • Locate passport/ tickets/ wallet/ keys before retiring on eve of trip

To be used with the general Travellers Checklist

Accessories

  • Sun Hat
  • Sunglasses - UV filters and polarised are best
  • Snow skiing goggles
  • Peg-less clothes line
  • Sun screen/lip balm/zinc cream
  • Small personal wash kit with towel
  • Pocket knife/corkscrew
  • Earplugs
  • Sewing kit
  • Books/music
  • Pen/paper
  • Spare batteries for camera, phone etc.
  • Plastic bags
  • Head lamp

Medication

  • All regular medications
  • Travel Bug Super Kit

Camping/Trekking Items

  • Water carrying items, eg. camel pack
  • Filtered water bottle (available from travel Bug)
  • Foam sleeping mat - two if extreme
  • Down sleeping bag
  • Trekking poles - adjustable
  • Ice axe/plastic mountaineering boots/crampons
  • Gaiters that fit your boots
  • Climbing gear - check carefully
  • Clothes
  • Warm woollen hat/beanie/balaclava
  • Thermal liner gloves/wind stopper fleece gloves
  • Fleece mitts with waterproof shell
  • Thermals - top and bottom
  • Goretex Jacket/separate rain over jacket
  • Long pants and shirt
  • Socks/underwear
  • Trekking Boots, eg. Mountain design Razor Backs GTS
  • Other boots for nights in camp
  • Blister kit/Trekkers feet kit/general first aid kit

Although it can be somewhat exhausting, travelling overseas with children can also be a very rewarding experience. Planning ahead can make a big difference when it comes to making the trip enjoyable. Most of the health issues that child travellers encounter are not from exotic diseases but from trauma, respiratory tract infection or diarrhoea. It is wise for parents to do a first aid course.

Diarrhoea

Children, particularly babies, are very susceptible to dehydration from fluid loss. Prevention of diarrhoeal illness involves attention to hygiene and choice of food and water.

Treatment:

Includes replacement of fluids with an oral re-hydration solution. Gastrolyte sachets mixed with boiled (boiled for 10 min) or bottled water, alternatives include juice or lemonade diluted 1:4 parts water.

Age Daily fluid intake
Babies < 2 months 600mL
3-6 months 1000-1400mL
> 6 months 1400-2400mL
  • Breast feeding and formula feeding should continue, and be supplemented with clear fluids from a bottle, cup or spoon.
  • Seek urgent medical advice if the child is listless, unexplainably drowsy, has dry mouth, prolonged high fever, and for a baby under 1 year of age with vomiting and diarrhoea for more than 24 hours
  • Avoid: Dairy, fatty foods, and wheat products.
  • If hungry, feed children with small amounts of rice crackers (substitute with toast or plain biscuits if rice crackers unavailable), steamed rice, bananas, or papaya.
  • If vomiting, give small sips of oral re-hydration solution frequently or encourage children to suck on ice chips (made from bottled water).

High Fever

A child with a temperature above 38oC should be given paracetamol-dosage as per weight/age (never exceed dose recommended). Undress the child to a nappy and keep cool, but do not chill. Rest and fluids are essential. Medical assessment may be required if fever continues to determine and treat the cause.

Medical Kit for Children

Include: Sunscreen, Insect repellent, Thermometer, Paracetamol, Gastrolyte, Wet Ones

 

Here are some links with useful information:

http://smartraveller.gov.au/guide/pages/travelling-with-children.aspx

http://www.holidayswithkids.com.au/

http://www.lonelyplanet.com/australia/travelling-with-children

https://www.your-rv-lifestyle.com/travel-children.html

Since August 2006, restrictions on liquids, aerosols and gels that can be carried on a plane have been put in place around the globe to prevent the threat of liquid explosives.

Always check with your airline what restrictions are in place before packing particular items.

Domestic restrictions are less onerous than the restrictions placed on international travellers.

Certain medications are exempt, though an authorisation letter from your doctor is a good idea. Generally quantities of less than 100mL for fluids MAY be ok but don't leave it to chance, do your homework and pack appropriately.

For more information go to: http://travelsecure.infrastructure.gov.au/international/lags/

Our objective is to give parents instruction and ideas, to allow your child or children to be given the best chance to cope on the day of their procedure. Creative use of language can ensure that ‘scary’ words can be reframed to let the young minds be reassured that they will be kept safe and comfortable; this can also affect the rest of their lives having created a positive experience/memory. We have found ‘telling’ the brain what feeling it can feel, using calm or creative wording, is better than suggesting it will be ‘like a bee sting’ (no one wants to be stung by a bee). Children are allowed to cry, they are allowed to be fearful, what they need to do is listen and we can help them be calm. Suggesting that your child be brave, or ‘be a man’, or it won’t hurt equally are not helpful.

Before coming in:

  • Remind your child that the health care professionals taking care of them are trained in what they are doing and the travel health visit will be short and easy
  • Refrain from using words to describe the procedure that bring on visual/mental imagery that cause anxiety - for example ‘jab’, ‘needle’ or words to describe the feeling like a ‘bee sting’ or ‘sharp scratch’
  • We prefer to use clean language or reframing words like - ‘we are creating immune memory’ - ‘we need to do this in a sterile manner by giving you a pinch of medicine’ - ‘this will allow your body to fight disease without having the actual disease’

While at the clinic:

  • Be clear in your mind which child is to go first, best if the most anxious goes first
  • If you have 2 or more children, please bring another adult to supervise your child because:
    • We discuss risks and benefits of vaccines with one of the attending adults without the children in the room
    • When we vaccinate, we do so without the other child/children present
    • We reinforce safe travel information with the child/children after the vaccines have been completed

After your visit:

  • Double binding is used - meaning - your child is here for their vaccine, they may be given the choice to sit on the bench or on a parents lap but are committed to be immunised today, then your child must get a positive message from you - if you are being immunised yourself, remain calm and positive, your attitude is also important
  • A reward for allowing the vaccines to be given is recommended
  • An analgesic (paracetamol) can be offered if required

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