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Frequently Asked Questions

Having been in the travel medicine business for more than two decades, and having given dozens of lectures and medical briefings on the subject, I have become well aware of the questions and concerns on most travellers' minds. While the answers to most of these questions are included throughout the rest of this site, I thought I would put together a list of frequently asked questions (FAQs) for your convenience.

Isn't DEET dangerous? It melted the leather on my purse!
I believe you about your purse, but having said that, it has proven to be exceedingly safe on human skin. Concerns about its absorption should probably be limited to small babies, who should definitely be using a lower concentration of DEET, e.g. 10%. Some people are concerned about its effects on the environment, if there are any, and if so, then choose something such as citronella. So, don’t drink it, don’t rub it in your eyes, don’t bathe your smal children in it, and keep it off your iPod.

Is 90% DEET nine times stronger than 10% DEET?
No. It is not "stronger". Rather it provides longer protection, much in the way that a sunscreen with an SPF of 30 will protect your skin longer than one with an SPF of 15. In Canada, DEET is available in concentrations up to 30%. In the USA, up to 50%.

I've read that drugs like Imodium (loperamide) are dangerous, in that whatever it is that is infecting your bowel needs, and wants to get out of there!
This is somewhat true. Antiperistaltics are felt to be safe if used to treat mild to moderate non-bloody diarrhea. In this case, a fluid diet and one or two Imodium might be all that is needed. If you are sicker, that is, have a fever or blood or pus in your stools, you should be using an antibiotic such as ciprofloxacin (Cipro) for up to three days, with or without an antiperistaltic. This is based on the fact that most cases of diarrhea are caused by bacteria. Most of these infections do get better on their own, so your decision on how to treat your problem might depend on how sick you are, how nice your toilet is, your supply of toilet paper, the length of your upcoming bus journey and your tolerance for discomfort. I usually choose Imodium plus Cipro.

For how long do you need to boil your water before it is safe to drink?
Getting your water to a rolling boil for just a minute is felt to be adequate. Doing it for longer will waste your fuel and cut down on the amount of water you have to drink.

Can I keep my mouth open when I shower in lesser developed countries?
Assuming that you are fortunate enough to find a shower (a hot one?), I doubt that this is a great problem. The likelihood of getting an intestinal infection depends to some extent on how much contaminated water one ingests, and I doubt that you'd swallow much in the shower. Having said that, this may not be the time or place for prolonged singing in the shower!

I have been using iodine to purify my water, but find I can't stand the taste. What can I do?
That's easy. If you find that your water is tasting like your laundry, this can be remedied by adding a vitamin C tablet, or flavoured crystals such as Koolade to your water. Remember, iodine alone does not always kill certain intestinal parasites, such as giardia and cyclospora. Pristine is a product containing chlorine dioxide. It is probably more effective than iodine, and doesn’t leave that horrible taste.

Next week I am flying to Australia. Should I be taking aspirin to prevent Economy Class Syndrome, that is, a blood clot in my leg or lung?
I think Economy Class Syndrome really refers to the envy that such passengers feel as they walk past the First Class section on the way to their less than spacious seats. But seriously, the zillions of people out there who take an aspirin a day are taking it to prevent a heart attack or a stroke, both of which occur from a blockage of an artery. There is no evidence that aspirin reduces the risk of developing a clot in the vein, which is what this syndrome is all about. Much more important is to drink lots of water, not so much alcohol and coffee, and to exercise (take a stroll) and stretch regularly while in flight.

Is it true that if I get caught using or smuggling illegal drugs in a foreign country that the Canadian / American Consulate will quickly get me out of jail?
Don't count on it! If you break the laws in a foreign country, especially this kind of law, you will be treated according to the laws of the land in which you got caught. Even Perry Mason wouldn't be able to help. Don't agree to carry any sort of package for other travellers unless you absolutely know what is or isn't in it.

I've heard that antimalarials are bad becuase they don't really prevent the infection, they just "mask" it. Any truth to that?
It is true that most antimalarials work by suppressing the symptoms of malaria. They do this by killing the malaria parasites as they leave the liver and enter your bloodstream. But in doing this, they prevent, or mask the symptoms, and considering that the symptoms of malaria include death or feeling like you want to die, this is felt to be a good thing. Remember, doctors don't really prevent everything, rather, we spend a lot of time suppressing things, or minimizing the risk of complications. This applies to hypertension, diabetes, depression, high cholesterol, psoriasis, and a whole host of other conditions.

Is it true that once you have malaria you will be stuck with it for the rest of your life?
You're not at all alone with this one, but the answer should be NO. There are 4 strains of malaria, and two of them, Plasmodium vivax and ovale may persist in your liver for many months and sometimes years. This can lead to relapses of your malaria. But this liver stage can be eradicated with the drug primaquine, though you might need a tropical disease expert to tell you that.

I have run six marathons and completed three triathalons. Do you think that climbing Mount Kilimanjaro will be a piece of cake for me?
You may not even feel like eating a piece of cake at high altitudes. Your level of fitness has nothing to do with your predisposition to developing altitude sickness. In fact, such a false sense of security and a tendency to bound up the mountain will certainly increase your risk. Your risk of developing the various forms of altitude sickness depends upon several factors, such as the altitude you attain, whether or not you take time to acclimatize before and during your ascent, your rate of ascent (no more than 1,500 feet per day is considered safe), your level of exertion, and how warm and well hydrated you keep. Common sense is much more important than fitness.

I'm told that using Diamox (acetazolamide) only masks the symptoms of altitude sickness and that its side effects are awful. Should I use it?
Diamox actually will prevent altitude sickness, or help to treat it if you already have it, and by preventing the illness, you prevent the symptoms. It does this by speeding up your acclimatization to the hypoxia (less oxygen) found at higher altitudes. To get a bit more scientific for the lawyers out there, it makes your kidneys excrete bicarbonate, which makes your blood more acidic. This in turn stimulates you to blow off more carbon dioxide, in an effort to maintain your acid-base balance. It is this increased respiration that helps you acclimatize better. The side effects are really not that bad - you might pee a bit more, and you may experience an annoying tingling around your mouth and fingertips. I recommend it for anyone who will not have the proper time to acclimatize, or someone who has had difficulty with altitude sickness in the past.

I grew up in India, so I really don't need to take any vaccines or antimalarials, do I?
Good question! Yes and no. You may have prexisting immunity to hepatitis A, which is transmitted via infected food or water. The majority of people who grew up in lesser developed countries were exposed to contaminated food and water at an early age, and though they didn't become ill at the time, did develop lifelong immunity. This can easily be checked with a blood test. The same goes for hepatitis B - depending upon where you were born, there is a reasonable chance that you have protective antibodies. But for all of the rest - typhoid, meningitis, tetanus, diphtheria and polio, japanese encephalitis, etc., even if you have been infected in the past, there is no guarantee that you still have immunity. With respect to malaria, those who live in malarious areas do develop some protective immunity, but unfortunately, this advantage is lost after living away from that area for some time.

If I am just taking a one week business trip in Southeast Asia and staying in 5 star hotels, do I really need any shots?
Well you sure don't need them as much as someone who is backpacking on a budget for six months, or someone going to visit their family in India, but that doesn't mean there isn't some risk. It's a good idea to be up to date with your routine tetanus-diphtheria-polio shot. Your food is only as good as the person handling it - consider hepatitis A vaccine. Finally, if you require medical care, or have unprotected sex while away, you are at risk of hepatitis B. So the risks are there, though they may be small. The traveller has to decide.

I started my hepatitis A and B vaccines last year, but never went back for the second and third shots. Do I need to start all over from scratch?
No you don't. In fact your immune system will be quite efficient at recognizing any subsequent boosters, so that it is sufficient just to continue on where you left off.

If I have had the rabies vaccine before I go away, do I still need to be vaccinated if I were to get bitten by a dog?
Absolutely! After you have been bitten, the most important thing is to thoroughly wash the wound with soap and water or some other antiseptic. Then you must get good medical attention. If you have had the pre-exposure vaccine, you still must have two doses of rabies vaccine (days 0 and 3) after the bite. If you have not had the rabies vaccine, again, wash the wound and get good medical attention. You then require a dose of rabies immune globulin, preferably injected into your wound. This may be quite expensive and difficult to find. As well, you then require five doses of rabies vaccine (days 0, 3, 7,14 and 28). I prefer to have my patients call me to ensure that they are receiving the correct treatment. Rabies is 100% fatal if not dealt with properly.

If I do get bitten by a dog, or a monkey, how long do I have until I start my rabies vaccine?
The rabies virus travels slowly up the nerve to the brain, so the length of time depends upon where you get bitten. Getting bitten on the foot would be preferable to having a chunk taken out of your neck. Having said that, you always have enough time to get to a big city where they have the proper vaccine, or even to fly home if necessary.

What vaccinations do I need to get back into Canada or the United States?
None. Nada. Zip. If you look like death warmed over when you return from Africa, the customs officials may detain you, for your sake and everybody else's. But no one will go checking you for immunizations when you return home.

My homeopath recommended that I undergo a parasite cleanse after I returned from six months in India. What do you think?
If that's what you want to do, go ahead, but I really wouldn't strongly recommend it. Firstly, the majority of people who return home with intestinal problems don't have a parasite. And if they do, either they are treatable with medications, or the parasite is not worth treating at all. Parasites are in fact quite common in the general population, and most of them live in harmony with you and your bowel. Having said that, I realize there is quite an industry in the "parasite business". I'm very skeptical.

Do you think it is a good idea to carry my own needles when I travel to the tropics?
It's not something that I push most travellers to do, unless you will be particularly isolated or for some reason accident prone. I do think that if there is a group travelling, that it is a good idea. As well, if you do choose to carry something, one of the ready-made kits, such as the Steri Aid kit, which also contains suture supplies, a small intravenous and sterile gloves, would be preferable to just a bunch of needles. Remember, if you do choose to carry syringes, whether it be for diabetes, allergies or whatever, carry an official looking letter signed and stamped by your doctor explaining why you are carrying them.

 
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