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Getting high!

November 19th, 2016 · Comments Off on Getting high! · Uncategorized

With the legalization of marijuana just around the corner, or already there, I thought I should write about getting high. Perhaps cannabis is a cure for altitude sickness, or perhaps one just wouldn’t care if he or she has a splitting headache and is vomiting incessantly on Kilimanjaro! The following is what I give to my patients. I hope you find it useful. Please refer to the links at the end.

The High Altitude Handout

Congratulations. You are about to get high! Here is some information regarding altitude sickness (AS).

Altitude sickness may occur at levels above 7,000 feet. Your likelihood of getting AS depends upon:

  1. How high you go (especially how high you sleep)
  2. How quickly you go high (are you flying to 12,000 feet or going by bus over a few days)
  3. How well hydrated and warm you stay
  4. The amount of exertion involved (i.e hiking vs taking the train)
  5. Luck, or your personal predisposition – those who have had AS in the past are more prone; age and fitness have little to do with it

Most people will feel a bit unwell – short of breath with exertion, lightheadedness, loss of appetite at high altitudes. This should go away within a few days. Some people also experience “periodic breathing”, or trouble catching your breath at night. The types of altitude sickness include:

  1. Acute mountain sickness (AMS) – headache, nausea, vomiting – usually beginning usually within 24 hours of arriving at your new altitude. Sounds a bit like a hangover!

If left untreated or if one continues to ascend with symptoms …

  1. High altitude pulmonary edema   (HAPE) – shortness of breath at rest, trouble lying down flat, cough and blood tinged sputum … this can be fatal!!!
  2. High altitude cerebral edema (HACE) – headache, confusion, difficulty walking a straight line, coma (this can also be fatal!!!)

To minimize your risk of getting AS, either mild or severe, consider the following:

  1. Getting to your destination gradually is preferable to suddenly flying to a high altitude. One does not always have this option!
  2. Taking it easy when you reach your high altitude …. consider sightseeing around Cuzco for a day or two before you hike the Inca Trail. On your trek, go slow…go slow…go slow!
  3. Drink lots of water (preferably clean water!)
  4. Consider the local remedies such as coca tea in The Andes or garlic soup in Nepal.
  5. Keep warm.
  6. Limit the change in your sleeping altitude to no more than 1,500 feet per day, and consider a day of rest every 3-4 days (applies to longer treks in Nepal)
  7. Don’t continue to ascend with symptoms of AMS. Descend if you are very sick or not getting better.
  8. Take along Diamox (acetazolamide) to use either preventatively (start the day before ascent) or if needed. It has three side effects – you will pee more often,  you might experience some tingling in your hands, feet and around your mouth, and carbonated drinks might taste funny… It may be used just for the first few days, or continuously if you continue to climb higher.
  9. Other meds, such as Decadron (steroids, for HACE) and Zofran (an antinauseant) and nifedipine (Adalat) (for HAPE) should be reserved for the minority of climbers on more dangerous expeditions, or those who are medically responsible for others.

For further information, read my website www.drwisetravel.com or The CIWEC Clinic in Nepal – www.ciwec-clinic.com
Photos below .. Machu Picchu in person, Kili and Everest from the air!

See my blog July 2011 Machupicchumania / March 2012 re Advil!

Mark Wise MD, DTM & H

mpkilimanjaro-2everest                                                                            

 

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Paris and plantar fasciitis

November 5th, 2016 · Comments Off on Paris and plantar fasciitis · Uncategorized

As a doctor and parent and volunteer and adventurer and student, I have visited more places than most. Somehow Paris has escaped me. Last week I am happy to say that it was taken off my bucket list. Here are some of my thoughts and suggestions.

Airfares from Toronto to Europe are quite reasonable. If you are an Aeroplan member, however, the regular fare is about the same as the taxes on your “free flight”. So I used my Aeroplan miles for my hotel instead.

I used Uber for the first time. Truly a magnificent advance in service and at a lower cost. (I realize that there may be some downsides to it). Imagine if our medical system could be revolutionized in a similar way.

I stayed at the Best Western Anjou Lafayette, close to the Opera Garnier and Gare du Nord. gdnNot the most trendy location, and I was urged in advance to stay on the Left Bank, but it was a relief to get away from the tourist areas at the end of each day.

Immerse yourself in the Metro as soon as you can. Between their extensive “underground” or “subway” and buses, you can really navigate Paris with little difficulty and quite inexpensively. I bought the carnet of ten tickets, which almost lasted me five days. metro2

If you are asking for directions in a foreign country in your second language, it never hurts to get a second opinion!

There are several “passes” available, such as the Paris Pass, which will cover your transportation and admission (without the lineups) to most, though not all of the most popular attractions. I didn’t use one, and I think I came out ahead. If you do register on their website in advance, you will be blessed with daily e-mails encouraging you to sign up.

Much of Paris is free! The churches like Notre Dame and Sacre Coeur, the parks like Luxenbourg and Tulieres Gardens, walking along The Seine and sipping coffee or wine on the streets. lux1

There is no additional GST and PST (aka taxes) on stuff in Paris, and tipping is not expected. So, while Paris isn’t cheap and the Canadian dollar is a bit anemic, it’s not as bad as you may think.

Try the Batobus for a day or two. It’s relaxing, not too expensive, and a good way to get from one end of the city to the other. Yes, Paris is great for walking and you can indeed walk most of the city, but a boat or a bus or the Metro might save you time and be easier on your plantar fasciitis! img_0931

Perhaps you enjoy playing the piano, like me! There are public pianos in all of the train stations, at Charles de Gaulle airport, and Shakespeare and Company’s bookstore. Along with the Eiffel Tower and the Arc de Triomphe, finding and playing the piano at Gare du Nord was a highlight of my trip, and life!
tower3

Try and find the statue of Montaigne by the Sorbonne. toe1It is believed to be good luck for students to rub his bronze toe before an exam. The statue is not sideways in real life! From there you can visit one of the world’s great bookstores, Shakespeare and Company, to browse or tinkle their ivories or both. Next door is a pleasant café. toe

piano-cdg piano-gdn

The fallafel at L’As du Fallafel in the Marais district is really as good as they say. Don’t miss it.

I borrowed Rick Steeves’ guidebook from my local library. I would highly recommend it.

I don’t sleep on airplanes, nor do I get HBO at home. So I was well entertained by a full season of Veep on the way over, and The Night Of on the way back.

If you are planning on picking up your own wine in Paris, take along a corkscrew or get one there. There really isn’t much in the way of screwtop bottles over there.

I saw seven SLR cameras in Paris. Everyone is using a smart phone. Selfies are the norm, and selling selfie sticks seems to be a common occupation amongst newly arrived French persons.

Speaking French certainly comes in handy. Remember to say “bonjour” when you address people.

I suppose the end of October is a bit off season. It still seemed like a very crowded city, though the lineups at most attractions were short. The leaves were turning colours, just like back home.

I have a fear of heights, probably dating back to trips to New York in my childhood, and aggravated by canopy walks in Ghana with my children. That saved me shlepping up the Eiffel Tower. There is a beautiful, and free, view in all directions from the seventh floor of the Galleries Lafayette (take the escalators up). img_0990

I have never before been a fan of fine art, but the Monets, Manets, Chagalls, Van Goghs, Cezannes, Rodins and much more enthralled me with their beauty, as did the museums and galleries where they were displayed.
img_0715img_0728
You can go crazy before you go doing your research on Trip Advisor. Here you can find the best hotel, best restaurant, best crepe or croissant, piano bar, and I am sure much much more. pizza1Pretty helpful, but sometimes it’s best to stumble on your own finds, and then, if you must, review them on TA.

As the Travel Doctor, I am exhaustedly used to warning people about the food and water, the bugs and advising vaccines. None of that was necessary for Paris. I think it is the most beautiful place I have ever been.

And,  below, the best pizza in Paris, at La Villa Andrea, close to the elegant Gare du Nord.

There are several people who advised me and encouraged me to take this trip. I thank you.

Please excuse the picture layout. I don’t find this program easy!

Mark

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Whaddya mean that’ll be 2500 bucks!

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!”

“Whaddya mean?”

“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.”

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It’s all about the roads ….

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!
trafic1BUS STATION KENYAbaboons kenya hiv biker

 

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The Natural Way – a guest column

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 lathparia@naturopathicfoundations.ca, or contact Naturopathic Foundations at 905-940-2727.

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More yellow fever stuff – please read!

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.

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Me and Muhammed Ali

June 5th, 2016 · Comments Off on Me and Muhammed Ali · Uncategorized

ali
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.

IMG_0129 photo 1 IMG_0149 IMG_0143 poster 3

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Yellow fever vaccine shortage

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?

  1. Those who have received the vaccine in the past are protected.
  2. 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.)
  3. You may want to postpone your holiday to Angola, or any other potentially area of risk.
  4. 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!
  5. Using a DEET containing repellent or Picardin day and evening is important.
  6. 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.
  7. 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!

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It’s just a virus … a flavivirus!

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.

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Something for your kids or grandkids

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.

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