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Means to End Chikungunya Menace? Report Raises Hope

Friday, February 19th, 2010 by Frank Gillingham, MD

New Scientist magazine is reporting a scientific advance that may hold the key to defeating  a mosquito-borne virus that turned dangerous and deadly and has been spreading across the world for the past five years. Carried by the tiger mosquito and driven by the forces of global commerce, chikungunya  virus causes fever, headache, nausea as well as excruciating pain in smaller joints, earning it the nickname “knuckle fever.”  This virulent form first appeared in the islands of the Indian Ocean but has since invaded every continent by way of airports and sea ports.   The CDC highlights some specific reports of recent activity in Indonesia, Thailand and Malaysia on their website, where they also offer advice to clinicians and travelers. 

Now the U.S.  National Institutes of Health (NIH) are reporting a breakthrough in the search for a vaccine by using genetic engineering to create virus-like particles which perfectly mimic the virus without being infectious. Tests with Rhesus monkeys have shown the vaccine to be completely effective against chikungunya. Testing in humans is likely to begin in one to three years.

The NIH’s work with chikungunya  may have ushered in a new era of vaccine production that could prove to be safer and more effective than the many live virus vaccines that are in use today.  It may only be a matter of time before vaccines created from pieces of viruses will replace those derived from whole, live viruses. Diseases such as Kala Azar, sleeping sickness and Dengue fever that afflict travelers to tropical regions do not currently have effective vaccines.  In principle, the creation of vaccines from virus like particles could someday eliminate that problem.

Photo info: http://www.flickr.com/photos/deadmike/ / CC BY-NC-SA 2.0

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Fungus Among Us? Don’t Forget Your Flip Flops

Thursday, February 18th, 2010 by John Wargo

Flurries floated to the ground as my taxi pulled up to the hostel in the Old Town of Stockholm. The facade of the hostel was immaculate and welcoming, unlike other parts of Europe where you truly get what you pay for.

I was stopping over in Sweden to visit my sister who was studying at the University of Stockholm. After a brief stay with her, my itinerary would take me through Finland and the Netherlands all the way down to the boot of Italy where I would catch a plane back to the states. I was pleased that I was able to fit all I needed (or so I thought) in my masterly arranged backpack, a skill inherited from my father.

My room in the hostel was just as expected, simple and efficient, something any Volvo owner would be proud of, with a shared bathroom down the hall. After my red-eye flight I was looking forward to a shower then meeting my sister for lunch. The first thing I looked for was my pair of flip-flops, and my heart dropped. In my mind I could see them sitting on my bedroom floor, across five thousand miles of Atlantic chop. Any (hygienic) college freshman values the flip flop. In the dorms, where 60-70 students share the same 10 showers, the flip flop offers protection from fungi, mycosis, athlete’s foot and any other sort of creepy-crawly hitchhikers that live in bathroom tile city. But I was in Sweden, one of the cleanest countries in Europe. The hostel was tidy and the bathroom looked better than the ones in my college dorm, so it must be okay to go sans flop, right? Wrong. I ended up paying the price in the form of a tag-along all the way to Rome, and he was no “fun-guy.”

Toenail fungus, known by physicians as onychomycosis, will affect 50% of Americans by the age of 70. Fungus infections occur when microscopic fungi gain entry through a small break or abrasion in the nail, then grow and spread in the warm, moist environment inside your socks and shoes. Symptoms of toenail fungus include swelling, yellowing, crumbling of the nail, streaks or spots down the side of the nail, and even complete loss of the nail. It is very difficult to cure so prevention is ideal. It helps to wear protective shoes or sandals in public showers, pool areas and gyms, and to avoid borrowing shoes or sharing socks or towels. Keep your feet dry as much as possible and change socks on a daily basis.

If you do develop a fungus, see a doctor.  You will want to be very clear about your symptoms, especially if you are in a foreign country. The common terms that we use in America don’t always translate well in other languages. For example, “athlete’s foot” in Italian is “il piede d’atleta”, but that won’t mean anything to a doctor; the medically correct translation is “infezione micotica.”  Once your condition is diagnosed, expect some common treatments such as trimming or filing affected areas and in severe cases, oral anti-fungal medication.

In conclusion, don’t let foot fungi uproot your travel plans. As inconvenient and unsightly as it is, fungi are easy to prevent — just think cleanliness. Also, don’t forget your flip flops, anytime you pack for a trip!

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Falafel, Shawarma and Pitas, Oh My! A Celiac Fights to Find Food in Israel

Monday, February 15th, 2010 by Jordan Silverman

I recently returned from a two week adventure in Israel with the Birthright program from the University of Delaware.  

Prior to leaving we were told we could bring a maximum of two bags each. Because I have a tendency to over-pack, this caused me some stress.  I managed, even though I had to dedicate one full bag to gluten-free foods.  I have celiac disease which means that many of the foods some people would grab for a quick snack are off limits to me.  Unless you have read as many food labels as I have, you probably can’t appreciate how many foods have wheat, rye or barley – ingredients that can trigger a revolt in your stomach and can cause long term damage to your intestines if you have celiac disease.  

As I was preparing for my trip, I began reading up on the popular foods in Israel — falafel, shawarma, pitas – and realized they are all made with bread! This could be an “oh-no” place for a celiac! I packed gluten-free cereal, gluten-free trail mix, gluten-free granola bars, fruit snacks, and a lot more. I knew I would have trouble finding things to eat.

The biggest problem was that I didn’t speak Hebrew and the locals didn’t speak English very well. It would have been so much easier in restaurants if I could have clearly communicated my food restrictions. Also, cross-contamination was a huge issue because foods are not always cooked by themselves or kept separate from others.  One night, while staying in a Bedouin encampment in the middle of the desert, we were served rice and meat inside a pita. After explaining my dietary restrictions to the staff there, they told me they could get me the rice and meat without the pita. GREAT! Except, not really, because the rice was mixed with orzo, another huge no-no for celiacs. That was a bad night.

The trip was amazing, and I am sure that other celiacs have traveled to Israel and have not had such a hard time. If you are going to a foreign country, bring someone who knows the language or a list of translations (companies like Select Wisely offer translation cards to help with this) regarding your food restrictions.  It will be so much easier to communicate your needs without confusion. Also, even if you speak the language, it is smart to bring extra snacks to have with you in case you can’t find something to eat. But most importantly, have fun!

Photo info: http://www.flickr.com/photos/jevnin/ / CC BY-SA 2.0

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Traveling Gluten Free

Wednesday, February 10th, 2010 by Emily Moran

Recently, a study was released regarding the increased prevalence of celiac disease. The Mayo Clinic in Rochester, MN analyzed about 9,000 blood samples taken in the 1950s and based on the findings reports that 0.2 percent of that population had celiac disease, but today an estimated 1 percent of the population has it. Celiac disease is a severe intolerance to gluten—a protein in wheat, barley, and rye. As more and more people are diagnosed, more organizations, websites, and blogs have been formed to help people find a variety of foods that are both tasty and gluten free.  

Over time those affected acclimate themselves to the labels, guides and menus available to help them navigate options in their favorite restaurants and grocery stores. But what happens when they go abroad? 

Because there is plenty of helpful information available, the celiac diagnosis does not have to deter anyone from traveling.  The National Institute of Health Celiac Disease Awareness Campaign is a good place to start—the travel section provides an outline of how to plan, travel, and then visit a different country. The Celiac Travel website provides even more detail.  One of the best features is free printable cards in 43 language describing celiac disease and the dietary limitations around them. They’re even available as an iPhone app! In addition to the general travel tips and tools, the “Celiac Travel Stories” section offers user-generated anecdotes and restaurant reviews. (For additional “traveling with Celiac” stories check out Celiac.com.)

The book Let’s Eat Out: Your Passport to Living Gluten and Allergy Free has compiled a list of country-specific Celiac organizations and information sources.  Use this information to help plan for and enjoy a worry free trip abroad. 

Do you have any travel-related or country-specific tips you’d like to share?

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Emerging Antimalarial Drug Resistance – Cause for Alarm

Tuesday, February 9th, 2010 by Frank Gillingham, MD

A report released yesterday by a United States Pharmacopeia program, in partnership with the World Health Organization, cited an increasing level of resistance to Artemisinin – the last affordable drug in the global arsenal against malaria.  The drug resistance is emerging in Uganda, Senegal, Madagascar, Cambodia, Thailand and Vietnam, and is thought to be due in large part to the sale of poor quality versions of Artemisinin in those countries.

The report indicated that between 16 and 40 percent of the drugs marketed as Artemisinin had impurities or did not contain enough active ingredient to be effective.  Drugs will typically lose effectiveness and allow parasites to develop resistance if not given at full strength or for the full recommended course. In the case of malaria, there is no useful replacement for Artemisinin currently available, and many could die or become gravely ill if the current trend continues.

“It is worrisome that almost all of the poor quality data that was obtained was a result of inadequate amounts of active ingredient or the presence of impurities in the product” said Patrick Lukulay, the director of the study.  Senegal had the most disturbing results, with over 40% of the Artemesisin based samples failing quality testing. Lukulay added “There are some countries where donated medicines are not subjected to quality controls, they are just accepted”.  This includes countries in Africa where Chinese products have been given and found later to be unacceptable.

Although results from other countries in the ten country study have not been released, preliminary evidence from the other countries surveyed – Cameroon, Ethiopia, Ghana, Kenya, Malawi, Nigeria and Tanzania suggest that failure rates in at least three of those countries were also high. 

Traditional antimalarial drugs such as malarone, doxycycline, chloroquin and mefloquin are still effective in many parts of the world where the malaria parasite is endemic.  In recent years, Artemesinin has been the last resort in areas where the parasite has developed resistance to these medications. However, for those travelling to sub Sahara Africa or southeast Asia, the risk of contacting Artemesinin resistant malaria is growing.  Although resistance is not yet widespread, it behooves the careful traveler to make sure that any Artemesinin based medication taken for treatment of a malaria infection is of good quality.

Photo info: http://www.flickr.com/photos/lonqueta/ / CC BY-NC-SA 2.0
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Thin Air Way Up There: Take the Risks Seriously

Friday, February 5th, 2010 by Frank Gillingham, MD

If you are planning a mountain climbing, hiking, skiing or snowboarding trip, you may have your sights set on a high altitude destination such as the Peruvian Andes or the ski resorts of Colorado.  These destinations carry with them the thrill of a tingling physical challenge as well as the risk of developing altitude sickness (also known as mountain sickness).

Altitude sickness results from your body’s decreasing ability to absorb the oxygen necessary to convert nutrients to energy because of the thinning of the air as you ascend.   This change results in symptoms that can hit anyone regardless of his fitness level.  In fact, it often strikes younger, more fit members of climbing expeditions and may be less common in those over the age of 50. Tolerance to high altitude varies tremendously between individuals, and can vary from trip to trip for the same individual, though cold weather seems to worsen the effects.

Anyone with chronic medical conditions or a history of asthma, lung or heart problems should discuss travel to a high altitude destination with a physician well in advance of travel. Individuals who suffer from the following chronic medical conditions should never travel to high altitude destinations:

  • Chronic Obstructive Lung Disease (including Emphysema and Chronic Bronchitis)
  • Congestive Heart Failure
  • Sickle Cell Anemia
  • Pulmonary Hypertension

It is common for those visiting a high altitude destination to breathe more frequently and experience increased heart rate and pulse. Dryness of the skin and mucous membranes occurs, as does a minor headache. These are normal characteristics of a body adapting to high altitude.

Severe symptoms such as these, occurring within the first 36 hours at altitude could be indicators of the onset of altitude sickness:  

  • Extreme increase in breathing frequency, with shortness of breath and/or cough
  • Very rapid heart rate with palpitations, chest discomfort or a perception of pulses in the neck and head
  • Severe headache
  • Nausea and/or vomiting
  • Fatigue and sleeplessness

Severe cases of altitude sickness can result in death, so it should be taken seriously. Mild symptoms of altitude sickness can be treated with rest at a stable altitude and acetaminophen or other analgesic (pain medicine).  If symptoms persist for more than 24 hours, seek medical attention. If possible locate a physician who is experienced in high altitude medicine.  Descent to a lower altitude is crucial. Never ascend if your symptoms are getting worse.  Some physicians will prescribe medications such as dexamethasone and/or nifedipine prophylactically for travelers to high altitudes, but this practice is controversial. 

To avoid altitude sickness, allow your body time to adapt to the thinning air, stay hydrated and follow all the normal safe-travel tips.  Food poisoning, jet lag and other situations manageable at regular altitudes will be much worse in high altitudes.

Don’t be up in the air about taking care of yourself; make sure you are grounded with good information and preparation.  Otherwise, you may be grounded longer than you planned.

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Feeling SAD? Therapeutic options for deep winter blues include travel

Tuesday, January 26th, 2010 by Frank Gillingham, MD

Seasonal Affective Disorder (SAD), better known as “winter depression”, describes people with normal mental health who become depressed during the winter months.  Officially, it is a form of depression that seems to recur annually. The malady appears to be particularly prevalent among college students, many of whom spend long hours during the winter months secluded in poorly lit dormitory rooms or libraries. 

The symptoms of SAD mimic those of clinical depression: excessive fatigue, lack of sleep, a tendency to crave unhealthy foods such as sweets and starches, and even suicidal thoughts.  Academic or work performance may suffer and interest in outside activities or relationships may dwindle.  Occasionally people who experience SAD go on to develop major depressive disorder or even bipolar disorder if left untreated.  The likelihood of developing symptoms seems to increase in those who have also experienced the shock of living abroad in a cold, relatively dark climate, such as the U.K. or Scandinavia. 

It is little wonder that spring break is a popular concept.  By the time February and March come around, people of all ages are desperate for some time in the sun.  However, those who experience SAD can ill afford to wait until the first warm day of spring.  Apart from the usual medications for depression, seasonal affective disorder may respond to light therapy, including sunlight or the placement of bright lights, cognitive behavioral therapy (learning to overcome adverse thoughts or actions through conditioning), melatonin, and even negative air ionization, which involves releasing charged particles into the sleep environment. 

Recognition is the key to early intervention and successful treatment, so if you suspect that you or someone close to you is suffering from SAD, it may be a good time to plan a sunny vacation.   Check out cloud cover probabilities around the world month-by-month with an interactive map from NASA’s Earth Observatory to make sure you maximize your chances of catching the rays you need. Or use the map as a possible predictor of where SAD is most prevalent.

Photo by: http://www.flickr.com/photos/bob_august/ / CC BY-NC-SA 2.0

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DVT: What You Need to Know

Friday, December 11th, 2009 by Frank Gillingham, MD

Immobilization can lead to DVT.One thing that‘s most likely NOT on your holiday wish list this year is Deep Venous Thrombosis (DVT), but if you are going to be traveling for any significant periods of time, you are at risk for developing one.  Regardless of your age or physical health, you are susceptible to these blood clots that form in the large veins well below the skin’s surface.  The Quasi’s Bell Tower blog recounts the experiences of one young, healthy American student who suffered through DVT last year in Romania. 

Generally, DVT occurs in the leg and if it stays there, you should be ok. However, a DVT can break off, completely or in pieces, and travel through your body up to your lungs. Once in your lungs, this condition is identified as a pulmonary embolus (PE) and could result in death.

Immobilization of any kind raises your risk of developing DVT — this includes immobilization on an airplane, in a car, etc. Other factors that can raise the risk of DVT include regular smoking, obesity, pregnancy, use of birth control pills, dehydration, recent surgery or other medical problems requiring hospitalization, certain types of cancer or heart disease, and structural abnormalities of the veins. Some people are genetically predisposed to blood clots — so your family history is important–and senior travelers may also be at higher risk.

Symptoms of a DVT often include leg pain or tenderness, redness, or swelling.  Symptoms of a PE often include chest pain, shortness of breath, and cough (sometimes with blood tinged sputum).

If you are planning a long trip, follow these tips:

  • Get up, stretch and/or walk around every 60 minutes or so. Request an aisle seat so it’s easier to do so. Bulkheads and exit rows also provide more leg space and easier entry/exit. If you can, elevate your legs intermittently during the flight.
  • Drink plenty of fluids to avoid dehydration (coffee and alcoholic beverages don’t count!).
  • Move around and exercise in your seat, making sure the seat presses up against a different part of your legs every once in a while. Don’t cross your legs for prolonged periods of time.
  • Medical Grade support stockings can be helpful and don’t require a lot of effort to either obtain or to use — ask your doctor or pharmacist.

If you develop any symptoms of a DVT, persistent leg pain, redness or swelling, or symptoms of a PE, shortness of breath, cough or chest discomfort, seek immediate medical attention.  If you’ve had a DVT or a PE in the past you’re more likely to get one again in the future.  And, keep in mind — the longer the flight or the car trip, the higher the risk.

Image by: exonumia  http://www.flickr.com/photos/exonumia/ / CC BY-NC-SA 2.0

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The Safe and Healthy Traveler’s Guide to Packing: Part Six – Managing Migraines

Wednesday, September 16th, 2009 by Maya Northen

migraineIf you are one of the 30 million plus Americans that suffer from migraines, you know how debilitating the sensitivity to light, sound, air pressure and movement can be.  Traveling with a migraine can be especially tricky, particularly when in a foreign country where the treatment options may not be the same as in the U.S. So while you are packing, consider the likelihood of needing to manage a migraine on your trip. 

Some migraines can be hormonal (mainly in women) and therefore the timing can be rather predictable. In these cases, try to avoid travel during times you are more likely to suffer a migraine. Though this isn’t fail-safe, it could help to decrease the chances.

For many, migraines can be quite unpredictable and impossible to prevent. However, there are a few things you can do to prepare yourself in case you do get a migraine while traveling.

If you have a history of migraines, bring any medication (over the counter or prescription) that has worked for you in the past. Keep it in its original bottle — to avoid trouble at customs — and make sure you know the generic name in addition to the brand name. Medications often go by different brand names overseas, but if you know the generic name, the pharmacist or doctor can provide a similar drug if you need it. 

A search for triptans (the most effective class of drugs for the majority of migraine sufferers) on HTH Worldwide’s mPassport mobile application returned this information:

Imitrex is available in the US as tablets (25, 50, 100 mg), or as a nasal spray (5, 10, 20 mg/spray).  It is most commonly called Imigran in other countries, although other names include Suvalan (Australia), Sumitriptan (Canada), Sumaptan (Egypt), Imiject (France), Migratan or Suminat (India), Imitag (Ireland), Sumatridex (Israel), Sumitran (Malaysia, Singapore), Sumamigren (Poland), Migralevel Ultra (UK) and even Dan Tong Jing (guess which country sell it as this).

But medications are only part of the plan. Migraines can be triggered by lack of sleep and physical stress. Try to adjust to your host country’s sleep/wake cycle as quickly as possible.  If you are taking an overnight flight and have trouble sleeping, an over-the-counter sleep aid can help you get some rest and adjust more quickly.  Melatonin, a natural hormone produced by the pineal gland, can be taken in supplement form to help you adjust your internal clock more quickly.  Both melatonin and exposure to the natural light cycle of your destination are widely recommended for reducing jet lag which may often bring on a migraine.

If you have problems with noise and light during a migraine, bring ear plugs and an eye mask with you on your travels in an effort to lessen your exposure to these potential triggers. 

Certain foods may enhance a migraine in some people. If this is you, bring along plenty of snacks that don’t amplify your pain to ensure that you have some food options that won’t bother you.

Then there’s caffeine — this is tricky as some migraine remedies contain small amounts of caffeine to open your blood vessels. However, some studies show that caffeine can actually make a migraine worse. Based on your personal experience, you will either want to embrace or avoid caffeine. 

If you tend to get nauseous from migraines, ginger pills (or candies) can be helpful to relieve nausea and can be found in most health food stores.

Stay hydrated. It may be tempting to try that French wine or German lager, but it probably won’t be worth it! Water is the best thing to drink during a migraine, especially on a plane where people are already prone to dehydration.

Stay active. This can be tricky when battling a migraine, but research has shown that exercise can bring relief. You don’t have to go for a 10 mile jog, but exploring your destination on foot for a few hours may allow you to use sightseeing as therapy.

Finally, choose your destinations and seasons carefully, if possible. Some people feel their migraines worsen in humid, high pressure climates, as well as at high altitudes.

By the way, the 14th International Headache Congress that met in Philadelphia over the weekend heard Cindy McCain give the keynote address chronicling her battle with migraines and the global prevalence of this affliction.  She is campaigning for a cure of what is considered by the World Health Organization as “one of the most disabling medical disorders in existence.”

Fellow migraine sufferers, share your remedies!

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You’re Grounded! (But you don’t have to be)

Friday, July 10th, 2009 by Moira Bishop

fearofflyingAn estimated 20% of adults have a fear of flying (aka aviophobia, aviatophobia and aerophobia), and the recent news regarding devastating airline crashes is causing more people to question the safety of air travel.  Is it safe to fly?  Is there a safer way to travel?  Should I just stay home and avoid the risk altogether?

As we have pointed out in recent posts, it is safe to fly.  Very safe, actually.   Air travel is the second-safest mode of mass transportation (elevators and escalators are the most safe but unless you’re Willy Wonka, an elevator isn’t an available mode of international travel).    

Should you stay home and avoid the risk of traveling?  That’s probably not a good option.  Even if you choose to avoid air travel for vacations, you probably can’t avoid it forever.  Your job may require you to travel or you may need to go visit a sick family member.

Fear of flying is a very real fear and is almost as common as the fear of public speaking.  Aviophobia can stem from other fears such as fear of tight spaces, crowds and heights.  There are real anxieties and conditions that cause the fear and there are also real treatments.  R. Reid Wilson, lead psychologist for American Airlines’ fear of flying program, surmises, “People frighten themselves by thinking of the possibility of a problem during a flight.  Instead, they must learn to think of the probability of a problem, which is extremely low.”

A recent CNN article suggests that overcoming the fear of flying starts with trusting your plane, your pilot and the aviation industry as a whole.

Dr. Martin Seif, a psychologist and creator of the Freedom to Fly program, urges those in his program to “Stay in the situation and out-bluff anxiety.”  The idea is that if you face your fear in small doses (i.e. spending time in an airport, watching planes take off and land, boarding a stationary plane) you will eventually be able to overcome them.

MSNBC offers Ten Tips for the Fearful Flier which are practical and reasonable. But if these tips don’t help, check out Fear of Flying or one of the many other safe flying programs available so that you’re transportation options are not limiting your vacation destinations.

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