How to deal with health issues that arise when we travel abroad

Summer holidays coming up soon? Will you be travelling by air? This week’s column looks at some of the health issues that arise when we travel abroad.

Depending on the destination, between 22 and 64 per cent of travellers report some illness; most of these illnesses are mild and self-limiting, such as diarrhoea, respiratory infections and skin rashes.

Travellers’ diarrhoea, defined as three or more unformed bowel motions in a 24-hour period during travel and for up to 7 days after travel, is most frequently caused by bacteria. The average duration of travellers’ diarrhoea, even if untreated, is 4 to 5 days. It affects 10 to 40 per cent of travellers. Of note, if you already take a proton-pump inhibitor for excess acid, it may increase the risk of travellers’ diarrhoea. In certain countries not only do you have to avoid tap water, but it’s best to avoid ice in your drinks and use bottled water to wash your teeth.

Standard self-treatment for travellers’ diarrhoea consists of oral hydration together with a medication to slow down the bowel (usually a drug called loperamide). For babies and older travellers it’s a good idea to travel with some sachets of an oral hydration preparation (for example Diorylate).

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What about bringing regular prescription medicines abroad with you on holiday?

In general, medication taken for many long-term conditions (eg asthma, heart disease and diabetes) will pose no problem with import laws as long as the medicine remains in its original container with its prescription label. However, some countries may limit the maximum quantity that can be imported for personal use.

Opioids and other drugs that act on the central nervous system may require a letter from the prescribing doctor. In some countries certain drugs are banned outright. For example, pseudoephedrine found in some decongestants is banned in Japan and cannot be carried into the country. The following checklist should avoid any major problems when travelling with your regular meds:

• Plan well ahead
• Check legal requirements that apply to the movement of medicines into and out of all destination countries
• Check with airlines and airports for local regulations on the movement of medicines
• Carry medicines in the original packaging with the dispensing label and patient information leaflet
• Obtain appropriate documentation from the prescriber

Are there instances when air travel could damage your health?

As a general rule, people with respiratory or cardiac disease with pronounced breathlessness at rest probably should not travel by air. This is because the cabin air pressure drops as the plane ascends to a pressure equivalent to that found on top of an 8,000ft mountain. The consequent decrease in the amount of oxygen carried by the blood, while not an issue for healthy travellers, can trigger medical problems in those with unstable angina, severe heart failure or severe respiratory disease.

In flight, the volume of air also expands by 30 per cent posing a potential problem for passengers who have had recent surgery. Flying within five to 10 days of an operation could result in the re-opening of wounds. Other contraindications to flying commercially include having a stroke within two weeks of travelling, an uncomplicated heart attack in the previous two weeks and within 10-14 days of a cardiac bypass.

In the last few years there has been less media attention on deep vein thrombosis (DVT) linked to air travel. The latest research suggests the incidence of symptomatic DVT in the month after a flight lasting more than 4 hours is 1 in 4600 flights. The risk increases by 18 per cent for each additional 2 hours in flight. But the risk of the clot travelling to the lungs causing severe pulmonary embolism is negligible on flights lasting less than 6 hours.

Whether you are heading off soon or later in the summer, I hope you have a most enjoyable and illness-free holiday.

mhouston@irishtimes.com