Why Travelers Visit ER.

(recently published in Conde Naste Magazine)
This is why you’re most likely to be hospitalized when traveling the globe—and how to avoid it.

These days, it might seem that the ubiquitous selfie, now considered deadlier than a shark bite, is responsible for the majority of life-threatening incidents suffered by tourists—in recent months, travelers have fallen victim to both crocodile attacks and death-defying falls in the name of getting that perfect shot. Yet despite being located all over the globe, emergency rooms tend to see the same issues come through their doors every day: stomach problems, chest pains, headaches, fevers, and coughs. And when it comes to travel destinations known for their mountain ranges or brilliant surf, for example, physicians working at emergency rooms are familiar with other ailments, too—those far more specific to their place on the planet.

Here, what travelers to Colorado, Central America, the Caribbean, and more, are up against.

Stings in the Sea

Where: The tropics

“In Hawaii, we see a lot of marine life stings and injuries,” says Howie Klemmer, M.D., the chief of emergency medicine at Queens Medical Centerin Honolulu. Yet, while (sometimes incredibly) painful, Klemmer says you can actually treat a jellyfish, rockfish, or Portuguese man-of-war sting—or a sea urchin-run-in—yourself.

Vinegar, for one, kills the venom-filled nematocysts [stinging cells] in a Portuguese man-of-war’s tentacles, he says, adding that most lifeguards in Hawaii carry vinegar-filled spray bottles and are trained in treating the stings. Just don’t rub or ice the area: “That causes the stinging cells to secrete more of the toxin,” he says.

As for a rockfish sting? That one will be particularly painful, Klemmer notes, but hot water (not scalding, but as hot as you can handle) will kill the toxins. If you’re in considerable pain or notice your pain getting worse, head to the ER to be safe.

The Flu

Where: Asia

It’s possible to pick up influenza anywhere. But, in general, thanks to concentrated, temperate cities in China and elsewhere across Asia, the flu spreads more easily, notes Christian Arbelaez, M.D., M.P.H., an emergency medicine doctor at Brigham and Women’s Hospital in Boston, Massachusetts who has traveled the world with groups like Partners in Health and participated in disaster relief for events like Hurricane Katrina. In fact, doctors in the field tend to look to Asia to see what kinds of flus might be headed toward other parts of the globe, he notes. A flu shot is an important preventative health measure no matter where (or if) you’re traveling. General hygiene practices like hand-washing, or carrying a decent hand sanitizer with you, can play a big part in keeping you healthy, too.

Mosquito-Borne Illnesses

Where: Latin America, the Caribbean, the Pacific Islands, the tropics

Zika, the mosquito-borne virus, made plenty of headlines this past year and in some places, it’s still a threat, says Arbelaez. In tropical areas, travelers are also more prone to other mosquito-borne illnesses, like West Nile, he notes. Pay attention to travel notices for Zika and other mosquito-borne illnesses. Zika—which doesn’t always show symptoms—poses a particular threat to pregnant women or those that could potentially be pregnant and their sexual partners, he says. Those at risk should avoid travel to infected areas—thankfully, there are currently plenty of Zika-free destinations to choose from.

Of course, Zika isn’t the only thing to be aware of. Travelers are also prone to other mosquito-borne illnesses, like dengue fever, Arbelaez notes. Those traveling to a malaria zone should visit a travel clinic in advance for malaria tablets—make sure to start them as directed, usually a couple of days before you arrive at your destination. In addition, try to stay at places with air conditioning and window screens, opt for long sleeved shirts, and use an EPA-registered insect repellant. Travelers to Brazil take note: The country is currently experiencing a yellow fever outbreak, according to Arbelaez, so make sure to get vaccinated before you go.

Altitude Sickness

Where: The mountains

“We are at 9,000-plus feet elevation, so we see a lot of people with acute mountain sickness,” Marc Doucette, M.D. the director of emergency medicine at St. Anthony’s Summit Medical Center in Frisco, Colorado says. If you’re in the mountains and notice a headache, nausea, difficulty sleeping, or shortness of breath, the high heights could be affecting you. (Docs also see more serious cases of altitude issues, called high-altitude pulmonary edema, when fluid develops in the lungs, he says.)

Keep altitude woes at bay by ascending slowly, suggests Doucette. Spend a night or two at 5,280 feet in Denver on your way up, for example. (You’ll be hard-pressed to leave the city’s Art Hotel.) Drink plenty of water and skip excess booze, too, he says.

And remember: “Having previously lived in the mountains or coming out here on a regular basis does not necessarily make you immune to altitude sickness.”

Foodborne Illness

Where: Developing countries; cruise ships

The Centers for Disease Control and Prevention (CDC) estimates 30 to 70 percent of travelers come down with cramps, vomiting, and diarrhea—a.k.a. “traveler’s diarrhea”—from contaminated foods. High-risk areas for foodborne illnesses include parts of Asia, the Middle East, Africa, Mexico, and Central and South America, the CDC says. Cruise ships—because of crowded quarters—can also be a hotbed for the stomach flu norovirus, notes Arbelaez (we all remember the headlines).

If you’re traveling to a high-risk destination, stick with bottled or boiled water, as H20 can be a huge source of contamination (and this includes foods, like salads and fruit, as well as ice cubes, that you might not think about), says Arbelaez. Make sure to visit a travel clinic before your trip for proper vaccinations and to ask about any preventative measures you can take (like filling preventative prescriptions). And if you’re off on a cruise, be vigilant about hand-washing.

Where are People Happy

Norway is the happiest place on earth, according to this year’s World Happiness Report by the United Nations Sustainable Development Solutions Network. The report is shared annually to mark World Happiness Day on March 20. It determines “life satisfaction” among 155 nations by using Gallup poll data to rank, as its overview explains, “the factors found to support happiness: caring, freedom, generosity, honesty, health, income and good governance.”

We’d add that happy locals create a welcoming environment for visitors, too, so one idea for your next vacation is to get to know the residents in one of the world’s happiest countries. Norway tops the list, jumping up from the number four spot last year. It’s followed by Denmark, Iceland, Switzerland, and Finland; the U.S. is number 14. Here are the top 20. For insider info on planning your trip to many of these cheery destinations, click through to our Insider’s Guides or Ask Wendy.

  1. Norway
  2. Denmark
  3. Iceland
  4. Switzerland
  5. Finland
  6. Netherlands
  7. Canada
  8. New Zealand
  9. Australia
  10. Sweden
  11. Israel
  12. Costa Rica
  13. Austria
  14. United States
  15. Ireland
  16. Germany
  17. Belgium
  18. Luxembourg
  19. United Kingdom
  20. Chile

 

Motion Sickness

(this article was recently in the New York Times about Motion Sickness)  Some good advice.

Motion sickness — an inner ear disorder that causes nausea, dizziness and even vomiting — is an unpleasant but common occurrence on car, boat and plane trips, says Dr. Jennifer Derebery, a physician at the House Clinic in Los Angeles who specializes in ear disorders. “Motion sickness happens when there is an imbalance between the eyes, inner ears and spinal cord, but fortunately, there are ways to reduce the chances of it hitting you,” she said.

Dr. Derebery offered these prevention tips.

LET YOUR EYES SEE THE MOVEMENT When motion sickness hits, it’s natural to want to keep your eyes shut or lie down, but Dr. Derebery recommends doing the opposite. “The key to recovering from motion sickness within minutes is to look toward the movement that’s happening, because doing so will reorient your inner ear,” she said. This means that if you’re in a car, look at the road ahead, and if you’re on a cruise ship, stand on a deck and look at the water or the horizon in the direction the ship is moving. You can’t see movement ahead while sitting on a plane, but staring out a window and seeing the clouds and the ground underneath you alleviates symptoms, Dr. Derebery said.

PREVENT THE ONSET You can prevent the onset of motion sickness or lessen its severity. On car trips, be the driver or sit in the front passenger seat because, in either instance, you’ll be looking ahead at movement. And avoid reading, watching television and texting — all can throw off inner ear balance, Dr. Derebery said. On planes, request the window seat, and on cruise ships, book a room with a window, preferably in the stern or back of the ship because this area doesn’t have as much up-and-down motion as the front of the ship.

HIT THE DRUGSTORE Over-the-counter antihistamines such as Antivert, Benadryl and Dramamine help with motion sickness — those prone to getting sick should take the recommended dosage an hour before their journey starts. These medicines can bring on sleepiness, and Dr. Derebery doesn’t recommend them if you’re driving. As an alternative to drugs, some may find motion sickness wristbands helpful. They have a button that presses a wrist point that affects inner ear balance. For cruises, she suggested getting a prescription for a transdermal scopolamine patch, which keeps the inner ear in balance.

EAT AND DRINK WISELY Fried food, spicy food and rich dishes like fettuccine Alfredo can worsen the nausea that comes with motion sickness. “These harder-to-digest foods increase the chances that you’ll throw up,” Dr. Derebery said. Before and during your trip, it’s best to stick to easily digestible foods like chicken noodle soup, bagels and crackers. To drink, go for carbonated clear liquids like ginger ale, which are helpful with nausea.

Tips on Traveling to China and other Asian Countries

This article was written by Dr. Ruth Nemzaff and was posted in Huffington Post

Before Leaving

1. Visit your local travel medicine clinic to be sure your immunizations are up to date.

2. Bring all your medications. Even the ones you only use occasionally. They are not available everywhere or the formulation is different. Take medications along in the event you are struck by travelers’ diarrhea.

3. Buy medical evacuation (medevac) insurance if visiting a country without excellent hospitals that meet the standards of the United States or your home country. A helpful, reputable website where you can shop for the best option for your needs is Squaremouth.

4. Call ahead and get a wheelchair! If you have less than a mile of walking in you, go online and ask the airport for transport from your plane to the immigration area or to your connecting flight. Save you walking stamina or some place more interesting. They will have a wheelchair and attendant waiting for you when you get off your plane. If necessary, they will have an electric cart. The service is free though you will probably want to provide a tip and you do not need medical certification.

5. Pack light. Weight is the enemy of all travelers, but for those with aching joints the heavy lifting and pushing become even more difficult.

6. Wear only comfortable, sturdy shoes or sneakers. This is not a time for glamour!

Once you arrive

7. Use bathrooms when you see them. You might not find another one for a while. Men with enlarged prostates and that’s’ most men over over 70 and many even younger lads do not have quite the control they used to and peeing by the road is frowned upon in most cities (though more acceptable in the countryside). In Asia, Western-style seated toilets can be a rare resource. If you can’t squat, go at your hotel or look for fancy restaurants. Be prepared to discard used toilet paper in a wastebasket and not flush it (plumbing can be primitive).

8. Follow good preventive health measures when eating. Those in developed countries take the FDA (or their country’s equivalent) for granted to assure our food supply is safe. Though even so we occasionally have a food-borne disease outbreak. In many developing countries there are no such protections. Do not eat uncooked vegetables or fruits you cannot peel yourself. Eat only hot food that has not sat around. Drink only bottled water and use bottled water for brushing your teeth. (Just think if it as washing your toothbrush in feces and you will follow the rule!) Assume that not everyone who handles your food has adequate washing facilities at home such as soap and running water. The hotel may be five-star, but the waiters and kitchen workers homes’ may lack rudimentary sanitation or clean water.

9. Do not eat street food, no matter how appetizing it may look. That includes ice cream.

10. Expect the unexpected. Be willing to change your plans. In the past, you may have enjoyed climbing 777 uneven steps with no railing to see a beautiful monastery. Now you may need to view it from a lovely restaurant on the next peak. If you hire a guide, make sure the guide will be willing to modify your plans if the walks are too long or difficult. The guide may know of alternative routes for reaching the pinnacle.

11. Take a break. In the old days you might have been able to go-go-go all day and then go out at night. Maybe not so much today. Either take a nap, if you love your evening restaurants, or if you are not a foodie go all day and then snack in the hotel. You may need to do both.

12. Travel with a caring, compassionate companion.It will be disappointing and frustrating at times. You might want to agree in advance that sometimes one of you will go ahead alone and the other will sit in a cafe observing or reading. You may have different physical challenges, so empathy will be indispensable.

13. Accept help. Think of it as a great way to meet kind caring people and to renew your belief in the kindness of humanity. You will find many barriers to entry unless you do. It could be a sandy boat ramp, a way to large step or a steep passage.

14. Talk to the people around you, exercising your usual good judgment. Meeting other people is as interesting as sightseeing and a lot less strenuous. People are very quick to let you know they are not interested in talking. A one-word reply is a good clue to move on.

15. Use a walking stick or a cane. It helps with balance on uneven sidewalks, open sewers and other unexpected obstacles.

16. Be grateful for what you can do, rather than bemoan what you can’t. This may take discipline, but it’s good practice.