Tag Archives: travel tips

International Travel Tips

Over-the-Counter Medications and Supplies:

  • Antacid
  • Antibacterial handwash
  • Anti-constipation (Dulcolax)
  • Anti-diarrheal (Imodium AD or Pepto-Bismol)
  • Anti-fungal (Monostat)-female travelers
  • Antihistamine (Benadryl)
  • Anti-inflammatory (ibuprofen)
  • Aspirin or other analgesic (pain-killer)
  • Bandages and antibiotic ointment
  • Cold tablets
  • Decongestant (Sudafed)
  • Hydrocortisone cream 0.5% t0 1%
  • Thermometer

Prescription Medications:

  • Sufficient supply of all your usual medications for a week beyond the duration of your trip, including antibiotics, oral contraceptives, etc. (leave a list of medications taken on your trip at home, preferably on an Internet-accessible computer)

Medical Alert Bracelet or Wallet Card:

  • For allergies, or a serious health condition

Other Considerations:

  • Waterproof Sunscreen with SPF 15 or higher
  • Insect repellant with 20% DEET
  • Extra pair of glasses or contact lenses

Special Medical Supplies:

  • Syringes for diabetics
  • Epinephrine (EpiPen) for serious allergy problems
  • Syrup of Ipecac if traveling with children (induce vomiting, if poisoned)


Unsafe Beverages:

  • Water or ice from hotel sinks, restaurants, and public restrooms
  • Unprocessed or chemically untreated water
  • Beverages from glasses with moisture on them
  • Carbonated drinks that are served with ice
  • Bottled water without a manufacturer’s seal
  • Raw milk

Do not use tap water to brush your teeth!

Safe Beverages:

  • Boiled or otherwise purified water
  • Internationally known brands of bottled water or carbonated drinks (without ice)


Unsafe Foods:

  • Foods that are not fully cooked
  • Foods prepared far in advance of eating
  • Foods made with eggs, mayonnaise, chicken, creams, or custards
  • Raw or partially cooked meats, fish, or shellfish
  • Foods served on dinnerware that is wet from washing
  • Fresh fruits and vegetables with broken skins or that you cannot peel yourself
  • Foods purchased from street vendors

Safe Foods:

  • Thoroughly cooked foods that are served hot
  • Fresh fruits or vegetables with intact skins
  • Foods that are packaged or canned
  • Rice, beans, or grains that are freshly cooked
  • Bread and other baked goods 

Getting Around Safely

Motor vehicle accidents are the leading cause of death of travelers to developing countries. Travelers involved in these accidents are also at risk for contracting serious illnesses through foreign medical system blood transfusions and injections (AIDS, hepatitis B/C).

  • Avoid overcrowded public vehicles.
  • Do not drive after dark (especially in rural areas).
  • Do not drive motorcycles (14 times more risky per mile traveled).
  • Wear a seatbelt.

Fresh Water

Slow-moving fresh water rivers, lakes, and streams in many developing countries should be enjoyed from a safe distance. It is common for these waters to be infested with parasites that are capable of penetrating the unbroken skin and causing serious illness.

If contact is unavoidable, towel dry vigorously  to reduce the risk of a parasite entering the skin, especially the feet.

High Altitude

Altitude sickness can have serious consequences and can even be fatal.

  • Make your ascent gradually, allowing time for adaptation on the way up.
  • Drink plenty of fluids.
  • Avoid overexertion (out of proportion to your physical condition and fitness level).
  • Avoid sedatives, aspirin, codeine, and alcohol.
  • Consider using acetazolamide (Diamox) preventively.

Asian Travel: Carry TamiFlu?

May 2006

Tamiflu (oseltamivir phosphate) is effective against most strains of influenza virus A and B.  This includes the Asian avian influenza (AAI), Type A H5N1 strain. This virus has been confirmed to have infected a number of people, with a substantial risk of death. Many were young, healthy individuals (as with the 1918 Spanish influenza pandemic).

Tamiflu can speed recovery by 1-2 days, and markedly reduces serious flu complications, such as secondary bacterial pneumonia.

To be effective Tamiflu must be taken within 48 hours of first symptoms: abrupt, high fever; cough/congestion; severe muscle aches; headache. There is no human vaccine available for the H5N1 strain, although work on a potential vaccine is ongoing.

So far, most of the AAI flu cases occurred by direct contact with infected poultry – chickens or ducks – or environmental surfaces contaminated by their feces/excretions. But, the concern that the bird Type A H5N1 strain could genetically mingle with more traditional human flu viruses, allowing it to become a lethal human flu strain, spreading human-to-human, is real; so real that countries have placed orders to stockpile millions of doses of Tamiflu. The Infectious Diseases Society of America has recommended that the U.S. stock 150 million doses.

The concern is for an influenza pandemic – multiple, concurrent continental epidemics worldwide. The 1918 Spanish influenza pandemic caused 25 million deaths in 6 months. The pre-condition for that pandemic as well as the one predicted to occur soon in the upcoming years (by the Asian A H5N1 strain or other flu virus) is an immunologically novel influenza virus for humans, with no immunity experience from prior illness with the specific flu virus strain or closely related prior flu virus strains or from influenza vaccines used in prior years. In other words, with an epidemic from a viral strain to which people are immunologically naked, 2.2 million deaths in the U.S. are predicted. Worldwide the toll would be unimaginable.

Although the Centers for Disease Control (CDC) has not yet issued a travel advisory for the general public, these facts should at least prompt consideration for carrying a supply (5 day treatment course) of Tamiflu by individuals traveling or residing in countries where  human or bird cases have occurred (and possibly contiguous nations, as well):


Animal Cases
Since December 2003, avian influenza A (H5N1) infections in poultry or wild birds have been reported in the following countries:
Africa: Europe & Eurasia:
Burkina Faso Albania
Cameroon Austria
Cote D’Ivoire Azerbaijan*
Djibouti* Bosnia & Herzegovina (H5)
Egypt* Bulgaria
Niger Croatia
Nigeria Cyprus
Sudan Czech Republic
East Asia & The Pacific: Denmark
Cambodia** France (H5)
China* Germany
Georgia Greece
Hong Kong (SARPRC) Hungary
Indonesia* Italy
Japan Poland
Laos Romania
Malaysia Russia
Mongolia Serbia & Montenegro
Thailand** Slovakia
Vietnam** Slovenia (H5)
Near East: Sweden
Afghanistan Switzerland
Egypt Turkey*
Iran Ukraine
Iraq (H5)* United Kingdom
South Asia:
Burma (Myanmar)
*human cases
**most cases human
For additional information about these reports, visit theWorld Organization for Animal Health Web site.Updated May 30, 2006

Availability of the drug locally cannot be relied upon and it must be started immediately upon becoming ill or after credible exposure (as an illness preventive strategy). Older flu drugs, amantidine and rimantidine, are not effective against this strain. Relenza (zanamivir) is effective, but cannot be used in those less than 12 years old or in those with respiratory disease (asthma, COPD, etc.).

Officials at the CDC and the World Health Organization (WHO) believe that the H5N1 Type A strain has become endemic to the birds in the affected regions and that human infections will continue. They feel it is possible this strain will evolve into a deadly human pathogen (once there is human-to-human transmission possible).

Asian Avian Flu Preparations

  • Regional Destination Disease Activity Information: update yourself: http://www.cdc.gov/flu/avian/index.htm
  • Asian Avian Flu Kit:
    • thermometer
    • alcohol-based hand rub for hand hygiene
    • Tamiflu 75mg twice daily x 5 days
    • In-Country Healthcare Resources: identify pre-travel
    • Medical Evacuation Health Insurance
  • During Travel
    • Avoid direct contact with poultry/fowl – live or dead.
    • Avoid poultry farms and bird markets.
    • Avoid handling surfaces contaminated with poultry feces/excretions.
    • Perform careful, frequent hand cleansing.
    • Thoroughly cook all poultry products – heat kills flu virus.
    • If you become sick abroad, contact U.S. consulate to locate medical services.
  • After Travel
    • If you become ill within 10 days of return, immediately notify your physician or a travel medicine/infectious diseases specialist, emphasizing the specifics of your recent travel.


Edward R. Rensimer, MD, FACP

Director, IMC

Coach Class/Economy Class Syndome

February 10, 2012

It is widely accepted that deep vein thrombosis (blood clot formation) or DVT in the legs is a risk of long-distance (greater than 5,000 miles) travel. The combination of immobility, dehydration, and seat pressure on veins at or below the knees increase the risk of blood clot formation. DVT is undiagnosed in 80% of cases. DVT may result in movement of the clot to the lungs (embolism) which accounts for 1 in 20 deaths in those older than 50. The incidence of DVT in the general (not hospitalized) population is unknown, but may be significant.

Risk factors for such clotting:

  • Prior history of DVT/pulmonary embolism (PE)
  • Obesity (>20% above ideal body weight)
  • Varicose veins
  • Recent surgery (with anesthesia) or physical trauma
  • Autoimmune disease
  • Type A blood type
  • Cancer/Chemotherapy
  • Clotting disorders (increased coagulability)
  • Congestive heart failure
  • Hyperlipidemia (elevated cholesterol)
  • Inflammatory bowel disease (Crohn’s/ulcerative colitis)
  • OB/GYN: Oral estrogens, Pregnancy/Post-Partum Period
  • Polycythemia/Elevated platelet counts
  • Limited mobility
  • Advanced Age

Although there are not sufficient data to routinely recommend preventive blood-thinning medications for air travel, graduated compression stockings have been shown to significantly reduce the chance of DVT in those with risk factors for excessive blood clotting.

Other highly advised recommendations:

  1. Attention to activity during the flight. Any activity that periodically (at least hourly) contracts the leg muscles (especially calves) is beneficial in keeping blood moving.
  2. Avoid dehydration by avoiding caffeine and alcohol, and by drinking liquids each hour.
  3. Consider routinely wearing gradual compression stockings (usually 15-30mm Hg pressure) for all lengthy (over 8 hours or 5,000 miles) plane flights and car trips.

IMC stocks top-quality, medical-grade stockings (ask our staff to show them).

Edward R. Rensimer, MD, FACP
Director, IMC