September 26th, 2016 · Comments Off on Whaddya mean that’ll be 2500 bucks! · Uncategorized
“Nice to meet you, Doc. From the looks of your office, you’ve done a lot of travelling.”
“That’s quite true, and I also get to travel vicariously through everyone else, like you two. What are you planning?”
“Well it’s our 40th anniversary, ya see, and we’ve been saving for a cruise to Southeast Asia ever since the kids moved out. We leave in three weeks and will be gone for two. Everything is first class!”
“Well let’s see. First, let me make sure you are up to date with your regular booster like tetanus. And it wouldn’t hurt if I gave you the pneumonia shot and the shingles shot. You’ve seen them on TV, and you are in your late sixties.”
“Is that all we need, Doc?”
“Oh God no. That just the start!”
“Well you’ll need a quick series of Twinrix, for hepatitis A and B, and typhoid for eating in the markets.”
“But we’re doing all of our eating on the ship. Maybe just some local beer on land. And isn’t hep B passed through sex?”
“I understand. Better safe than sorry, as the saying goes. Let me mention two other vaccines I think you should consider – rabies and Japanese encephalitis.”
“Oh, my wife loves dogs. Thanks for suggesting that. What about the Japanese thing? Is it common? We aren’t stopping in Japan, and we’ll be on the ship every night after five.”
“Estimated at one in a million travelers to the area. But it only takes one mosquito. Better safe than sorry, as the saying goes.”
“Hmmmmm. I appreciate your advice, Doc. Can give me an idea of how much all of those vaccines will cost us?”
“Well the tetanus booster is free. The others … let’s see …. for the two of you, it would run about $2500, and then of course there’s the consult fee, and you will need to come back two more times.”
“Any side effects, Doc?”
“Probably just a sore arm.”
“Thanks Doc. Sounds a bit pricey, and mostly unnecessary. You won’t be living vicariously through us! Adios.”
Tags:cost vaccines·travel clinic dr. wise
August 15th, 2016 · Comments Off on It’s all about the roads …. · Uncategorized
Zika, dengue, diarrhea, dogbites, sunburn …. these are a few of my favourite things, as Julie Andrews sang in The Sound of Music.
But what do I really worry about with my travelers?
Accidents … mostly of the motor vehicle variety.
With the Olympics and Donald Trump so pervasive in the press, probably most of you don’t notice headlines like this (bus accident in Nepal) or this (bus accident in Peru). While the traffic in Toronto and wherever you live is horrendous, and accidents happen everywhere, they are much more common in lesser-developed countries.
Why? Lousy roads, overcrowded, poorly maintained cars and buses and drunk drivers just to name a few reasons. I was in Peru in 1973, and Nepal in 1999. I’d bet that not much has changed. If I were to return, I might think twice before getting on the same roads and buses …. getting old!
Here are some suggestions for minimizing your road risks, realizing that all may not be practical, available, affordable or exciting!
- stick to well-built vehicles with uncracked windshields, functioning rear-view mirrors and seatbelts
- wear your seatbelt
- avoid nighttime travel, especially in rural areas (I know it might save you money and a night’s lodging)
- sitting in the back of the bus might be safer than the front (in Ghana, I recall being honoured with the front seat by the driver.. The goat went in the back!
- if the weather looks really bad, stay put
- the more expensive bus is probably safer
- if you are the driver, don’t drink … or text … and drive
- consider using a local driver
- motorbikes are a lousy idea
- if you have small children, car seats are a good idea
There is more to your personal safety than your mode of transportation, but this is a start.
By the way, the yellow fever vaccine shortage seems to have been resolved!
Tags:doctor wise·road safety·travel medicine·yellow fever vaccine
July 5th, 2016 · Comments Off on The Natural Way – a guest column · Uncategorized
Enough of yellow fever shortages and Zika. I think you will find the following information from my naturopathic friend and traveler of interest and benefit! Thanks Leena
Travel medicine has come a long way in the last few decades. People are travelling more than ever before which has dramatically increased travel-related health concerns. While conventional MDs are skilled in running lab tests, prescribing pills & injections to address these potentially fatal concerns, there are often missing pieces in the health puzzle which naturopathic medicine aims to put together.
While naturopathy recognizes the importance of accurate diagnosis and medical interventions, the naturopathic model incorporates prevention with a focus on strengthening your system and addressing the root cause rather than fixing the symptom. Naturopathic doctors are regulated in Ontario and have training in conventional medical diagnosis & natural treatments such as nutrition, nutraceuticals, Asian medicine & acupuncture, botanical medicine, supplements and other modalities.
The naturopathic approach to travel medicine is multifaceted. One aspect is prevention. What are ways to prevent you from getting sick in the first place ?
There are various ways to support your immune system to fight germs. Why is it that two people may be travelling, eating the exact same foods while one person gets terrible diarrhea and the other one is fine? Both were likely exposed to the same germ but one person had the ability to fight it off. By supporting your immune system, you can reduce your chances of getting sick on a trip. (Below are some suggestions to support your immune system.)
Naturopathic doctors in Ontario do not prescribe pharmaceutical medications, however they are trained in understanding their side effects and have access to a variety of natural options to choose from. For example, while Gravol is widely used for nausea, some people do not like the drowsy effect and may opt for natural options such as Ginger or Vitamin B6. Another aspect is to minimize the side effects of pharmaceutical medications. For example, there are many medications that target bacteria that causes diarrhea. Antibiotics can work well to kill that bacteria, however they also eliminate beneficial bacteria in the gut which can make you susceptible to re-infection. If antibiotics are prescribed, naturopathic doctors will often suggest specific probiotics to support healing.
Naturopathic medicine recognises the body-mind-emotions connection.
Travelling can increase anxiety – fear of flying or anxiety of new environments can put a damper on travel. Naturopathic doctors can customize herbal formulas to reduce anxiety. Herbs such as lavender, passionflower or lemon balm soothe the nervous system, however are best taken under guidance so as not to interact with medications you may be on.
Naturopathic Tips for Travelling :
Support your Immune System
Before your trip, it is advised to balance your immune system to help you fight unwanted infections.
- Eat nutrient dense foods packed with antioxidants, such as berries, cocoa, chia seeds and whole fruits and vegetables.
- Supplements such as Echinacea or Astragalus, Vit C & D, Zinc can be individualized based on your constitution and your health concerns.
- Get sufficient sleep and rest before the trip.
Support your Digestive System
The digestive system is a complex yet delicate system in our bodies, and is most commonly affected while travelling when we are consuming new foods in new environments.
- Electrolytes are a must when travelling in hot climates or when experiencing diarrhea, as they help rehydrate the body and provide mineral salts.
- Digestive enzymes and herbal bitters can support digestion, assimilation and elimination of food.
- Probiotics are critical in supporting intestinal flora – how much, when and which type should be customized based on your travel destination and your current state of health. There are many options of probiotics that are shelfstable which can remain viable on your trip.
- To prevent or treat parasitic infections, herbs such as neem or black walnut have antimicrobial properties. Best to take under the guidance of a naturopathic doctor. In certain cases, your MD may also prescribe medications for you.
- Other herbs such as slippery elm or marshmallow root can be taken to soothe the digestive tract if there is inflammation or irritation.
Naturopathic medicine can work in supporting your health needs in addition to conventional treatment at your travel clinic. Working alongside your doctor to ensure your health needs are taken care of before, during and after the trip, we can support your body’s innate ability to fight germs, adapt to new environments naturally and effectively so that you can continue to enjoy travelling.
Dr. Leena Athparia is a naturopathic doctor with an interest in travel health & treating chronic health concerns. She has travelled extensively to many countries in Asia, Europe, Middle East and South America and has had first-hand experience with naturopathic travel medicine. Leena has a particular focus in Ayurveda, Traditional Chinese Medicine & Acupuncture which she incorporates into her naturopathic practice. If you would like to book an appointment with Dr. Leena Athparia ND, please email her at firstname.lastname@example.org, or contact Naturopathic Foundations at 905-940-2727.
Tags:dr wise blog·naturopath·travel medicine
June 27th, 2016 · Comments Off on More yellow fever stuff – please read! · Uncategorized
If you are coming to my office regarding a trip to parts of Africa and/or South America,this information is important to you. There continues to be a shortage of yellow fever vaccine. This may last several months. Yellow fever vaccine is protective for life. Please read my blog of May 29th.
If you have had a documented yellow fever shot, you are protected for life. It is unlikely that I will give you another, even if your previous one was more than ten years ago. I will “validate” your yellow card.
If you are going to Tanzania, it is felt that yellow fever is NOT a risk. There may be “bureaucratic” concerns. I will likely provide you with a yellow “certificate of exemption”.
For those with very brief, low risk exposure to YF, e.g Iguacu Falls or the Peruvian Amazon for 3 days, you will be offered the vaccine after a discussion of other risk factors, such as your age.
Studies have shown that using .1cc, or one fifth the usual dose, is protective against YF. This may be an option for some, after discussing the issue.
So, please make sure that you are aware of these issues before your appointment with me, or perhaps anyone else.
A list of all clinics attempting to provide YF vaccine is found on my previous blog.
Tags:shortgae·yellow fever vaccine
June 5th, 2016 · Comments Off on Me and Muhammed Ali · Uncategorized
Cassius Clay, and then Muhammed Ali, was my idol. I was born in 1950, and when he won his gold medal in Rome in 1960, I jumped on board. I never boxed, but I loved professional boxing. His speed, his shuffle and his way with words to say the least, mesmerized me as a youth. I had other favourites, like Gordie Howe, Mickey Mantle and Elvis Presley, but Ali was my only idol.
Even before he became the champ, I remember being glued to my transistor radio to follow his fights. When he won the title over Sonny Liston in 1964, I was the toast of my junior high school, along with the other three members of my Cassius Clay Fan Club. I took my own stab at poetry and sent it in to Sports Illustrated.
The odds were 7 to 1,
But when the fight was done
The people lost their money,
That is those who bet on Sonny.
Cassius Clay is the greatest by far,
A tomato red Cadillac is his car.
He came from the town of Louisville,
To prove that Liston was over the hill.”
There were a few more verses which I can’t remember. Today, I am rereading all of my Sports Illustrated magazines where Ali graced the cover.
I first met Ali at the gym on Ossington when he was training for his fight with George Chuvalo. He was sparring against his younger brother. I was there with my older brother, Joel. We ran into each other again a few years later (I suppose I was stalking him) in the lobby of the old Sutton Place Hotel. He was under suspension at that time, and was doing colour commentary for the Clyde Gray fight. Luckily, Joel was able to snap the picture of Muhammad and me.
For my sixtieth, I flew to Louisville to visit The Ali Center. I have been to more than a few museums during my life. This was one of the best. You should go to see it. For
so many reasons, Ali was and will remain “The Greatest”. I feel fortunate that he is my idol.
Tags:dr wise travel·IDOL·MUHAMMAD ALI·THE GREATEST
May 29th, 2016 · Comments Off on Yellow fever vaccine shortage · Uncategorized
If you are planning a visit to an area where yellow fever is a threat, you should read this. If you are one of my travel patients coming in regarding yellow fever vaccine, please read this! Some key points about yellow fever:
- as mentioned in the previous post, it is a flavivirus, that is, in the same family as West Nile virus, Zika, dengue and Japanese encephalitis
- it is transmitted by mosquitos
- it may occur in both urban and rural areas
- it is a very serious illness, affecting most of the body’s organs, with a mortality rate of about 20%, and no specific treatment
- its distribution is limited to subSaharan Africa and parts of South America
- it is the only infection for which there are international and national “requirements” for vaccination
- the famous “Yellow Card” (not the one used in football) may be required to prove that you have received the vaccine
- yellow fever vaccine is administered only in “designated” clinics
- while it has been traditionally felt that the vaccine, which is 100% effective, provided about 10 years of protection, those in authority (WHO) have stated that it in fact provides lifetime immunity
For further information on yellow fever and the vaccine, you can check the following links: PHAC (Canada), CDC (USA) and the WHO (the world).
Unfortunately, the world is currently undergoing an acute and severe shortage of the vaccine. This was likely precipitated by a recent outbreak in Angola in West Africa. Cases of yellow fever were also reported in neighbouring countries, and not so neighbouring countries, like China. People and the viruses do travel. Uganda also has a local outbreak, unrelated to the one in Angola. Vaccine production is not that simple, and it appears that production problems, which are not totally new, are also responsible for the shortage.
There is the very concerning and real threat that yellow fever could take hold in countries and continents that have always managed to stay free of the infection. There are apparently only four manufacturers of the vaccine worldwide (Sanofi Pasteur in North America), and I assume their priority is supplying vaccine for the affected and potentially affected countries.
So what does this mean for travelers planning to visit a “yellow fever” country?
- Those who have received the vaccine in the past are protected.
- You may have to call around (hopefully travel clinics can help) to find a clinic with vaccine in stock. (I assume most of us won’t have enough to meet the usual needs.)
- You may want to postpone your holiday to Angola, or any other potentially area of risk.
- The risk of yellow fever is VERY LOW for many of the destinations, especially brief ones, to which people travel (e.g Iguacu Falls, the Peruvian Amazon, Kenyan safari). We have already been using the vaccine much less, particularly in certain populations, dare I say “the elderly” = over 60!
- Using a DEET containing repellent or Picardin day and evening is important.
- There is good evidence that giving a smaller dose of the vaccine, 0.1 cc as opposed to 0.5 cc, might be effective and thus help stretch limited vaccine supplies. I am not sure that this will contribute to the solution.
- There remains the logistical challenge of providing the yellow card, or perhaps a letter of exemption, where the vaccine is not available.
For further information on the situation, keep in touch with your travel clinic, and the above mentioned organizations.
If it helps, I have just returned from a brief trip to Newfoundland. I saw icebergs, but no mosquitos!
Tags:dr wise travel·yellow fever vaccine shortage
May 14th, 2016 · Comments Off on It’s just a virus … a flavivirus! · Uncategorized
For most of us, “a virus” is just a cold, a runny nose, a sore throat, a cough, some aches and pains, or if we are lucky, some transient vomiting and diarrhea. When we travel, it may be the same, with the added possibility that you might contract dengue fever, Zika virus, Chikungunya virus, Japanese encephalitis, and Yellow Fever. All of these viral infections are transmitted through the bite of mosquitos. They belong to the family FLAVIVIRUS . Some of them bite during the daytime, and some between dusk and dawn, like malaria. It is probably best if you consider some “personal protective measures”, no matter where you you go and regardless of when you are there. For some guidelines, for yourself and your children, please go to PHAC.
Dengue fever has been on the upswing for many years, perhaps because of global warming, urban migration, poverty and smart mosquitos. There is a new vaccine against dengue, which is moderately effective, and which is available in only a few countries. Chikungunya virus became entrenched in our western hemispehere last year. It may have subsided, only to be replaced by Zika virus.
Zika virus, though it may only cause a mild illness, with a fever, joint pains, red eyes and a rash, may also be associated with much more concerning complications such as fetal abnormalities and Guillan Barre Syndrome. To stay up to date with Zika virus, please check my blog.
May 7th, 2016 · Comments Off on Something for your kids or grandkids · Uncategorized
A bit of a change. Rather than discussing scary new mosquito-borne diseases, like Zika (please refer to my previous post for updates), I thought I would highlight one of my travelling friends and patients. Sarah Kraftchuk recently climbed Kilimanjaro, but equally important to me, are the lovely and touching and meaningful books she is publishing.
I have given her beautifully written and illustrated book to all of my grandchildren, Hannah, Isaac, Jonah and Noah. I think you and your family will enjoy her books as much as my family.
Tags:children's books·sarah kraftchuk
January 19th, 2016 · Comments Off on Zikamania · Uncategorized
Every year or two a disease outbreak pops up that lights up our telephones. This week, it is the emergence of Zika virus in countries in South and Central America, Mexico and the Caribbean.
Rather than overwhelm you with details, let me give your five reputable websites so you can do your own research. Zika virus tends to cause a milder illness (fever, aches and pains, weakness, a rash, red eyes) than its cousins, dengue fever and Chikungunya virus. They are all transmitted by the Aedes mosquito, which prefers to bite during daytime hours.
For years we have been recommending personal protective measures against mosquitos – DEET containing repellents (there are alternatives) and clothing for travellers going anywhere in the tropics, so Zika should not present an alarming threat to travellers. While there is a new vaccine against dengue fever (not yet available here), there are no vaccines against Chikungunya or Zika virus.
The heightened concern, however, is that the Brasilians have noticed a marked increase of microcephaly (an abnormally small head), in children born of mothers who might have had Zika virus. So there is a suspected, though not proven, association between the virus and microcephaly.
What should travellers to these areas do?
If you are not pregnant, have a good time and use personal protective measures against mosquitoes.
If you are pregnant, consider not travelling to these areas.
And .. if you might be pregnant, or hope to get pregnant, you have two choices – postpone your trip …or go and be religious about your insect precautions.
Here are the five reputable websites for you:
Public Health Agency of Canada
Centers for Disease Control (US)
World Health Organization
Pan American Health Organization
Society of Obstetricians and Gynecologists of Canada
Tags:chikungunya·dengue·zika virus dr. wise blog
January 8th, 2016 · Comments Off on The telephone and me · Uncategorized
On March 10, 1876, Alexander Graham Bell made the first telephone call (albeit to the next room) to his assistant Thomas Watson. The first words spoken were ” Mr. Watson …come here. I want you“. We have come a long way since then. We can call from our cell phone (even better than Maxwell Smart’s shoe phone), and on the receiving end, we have such tools as call display, multiple lines, answering machines and headsets. And then there is e-mail!
Rather than hearing Alexander’s voice on the other end, you will probably be greeted by “Your call is important to us. If you know the extension of the person you are trying to reach, dial 1. If this is a medical emergency, proceed to the nearest emergency department.”
In all seriousness, my clinic and I give a lot of guidance, and advice, over the phone. Many travellers who call would like to get all of the information over the phone. “We are going to India for a month. What shots do we need?” It saves them the dreaded trip, perhaps with kids, into my office. The traffic is not to be underestimated in Toronto these days. It also saves them the cost of my professional advice!
As mentioned, we do guide, more than most clinics, over the phone. My staff, who have been with me for years, know travel medicine as well as I do. They diplomatically use phrases such as:
- Dr. Wise might recommend this
- Dr. Wise usually suggests this
- it depends upon what shots you have had before
- how soon are you leaving
- are you climbing Mount Kilimanjaro
- you should probably sit down with Dr. Wise and he will explain everything and answer your questions
- it may cost this
- there may be other issues, like malaria, dengue, safe sex, motor vehicle accidents, traveller’s diarrhea, and the fact that your medical history is as thick as Gone With The Wind
- you could check out his website, and CDC and the Public Health Agency of Canada.
- and when push comes to shove, “Can I please put you on hold!”
- feel free to call back and make an appointment
They DO NOT use the phrase “ Don’t worry. You don’t need anything. Have a nice trip.” While “What shots do I need?” is an important question, it is usually not the sole or most important information that you need. And, the answer to that question depends upon many factors, such as your destination(s), the duration of your trip, the “style” of your trip, your departure date, your past immunization history, your risk tolerance and your budget.
The downside or pitfalls of telephone advice include:
- I do not get a full picture of your trip or medical history or particular concerns
- you just seek advice regarding “the shots” and not the numerous other issues that are at least or more important
- there is usually no record of your conversation if you are not seen in person
- in spite of perhaps not needing any shots, you succumb to malaria or dengue fever or Montezuma’s Revenge or motion sickness or altitude sickness or contract rabies or HIV or fall off your motorbike, or all of the above
- you will feel badly if you get sick from something about which you weren’t aware
- I might feel badly, and even liable, if I didn’t get the opportunity to advise you properly, in person, and document my advice
- I, and all travel medicine professionals, enjoy and earn their living by providing up to date, appropriate travel medical advice … which in my opinion, can’t be given over the phone!
My tan, from Cuba, is slowly fading. I am now reading Red Heat. Conspiracy, Murder and The Cold War in the Caribbean. You might find it interesting. Today’s Globe and Mail also has a great column about modern day Cuba by Stephanie Nolen.
Tags:blog·cuba·dengue fever·dr. wise·stephanie nolen·telephone advice·travel medicine