What’s in Your Suitcase? Must-Haves for a Healthy Vacation

Leslie Laine: Welcome to Premier Health Now On-Air. It's vacation time and we're talking summer travel, at home and overseas. We have tips and some cautionary tales straight from the source so you can know how to have fun safely on your travel adventures wherever they take you.

Leslie Laine: We're glad you're along. I'm your Moderator, Leslie Laine. With me today is Dr. Matthew Stone, a Primary Care Physician with Middletown Family Practice. Thanks so much for joining us.

Dr. Stone: It's my pleasure.

Leslie Laine: You and your family are well-traveled, I understand, and you've seen your fair share of travel-related issues in your own practice, correct?

Dr. Stone: My kids have been to 15 countries, almost every continent, and yeah, unfortunately, in 20 years, I've seen a lot of travel injuries.

Leslie Laine: Well, before we go, what kind of research can get us off to a healthy start?

Dr. Stone: I think knowing where you're going to go and what kind of obstacles you're going to see is the biggest step that you're going to take as a traveler. If you're heading to the Grand Canyon and you want to travel down Bright Angel Trail, you better know that it's a one mile drop, 12 miles to the bottom, and if you're coming back, it's like running a marathon so you need to be prepared.

Dr. Stone: If you're talking about high altitude, are you good with high altitude? Do you have any respiratory issues? And then, just the heat. If you're going to go out to the desert, do you have the right equipment to be out in the desert? So you want to know what you're going to see when you get there.

Leslie Laine: I do know someone who went down Bright Angel Trail with one bottle of water.

Dr. Stone: Yeah, we did it, and we only made it about three miles down, and wisely turned around. Unfortunately, that day, a guy died on the trail. He tried to make it up and back.

Leslie Laine: Well Triple A always suggests giving your car a good checkup before you go on a long trip. So who should get a health checkup before traveling? Especially if you're going down Bright Angel Trail?

Dr. Stone: Absolutely. I think anybody who's not a regular exerciser needs to go talk to their doctor. If you can't walk up and down a flight of stairs, the changes you're going to climb Machu Picchu at high altitude are probably pretty slim. So I think you want to talk about what kind of exertion you expect, and specifically, what health conditions you have that might limit them.

Leslie Laine: And what kind of a checkup might I expect to have?

Dr. Stone: I think a discussion about your activity level. And again, back to some specifics, like if you have a cardiac condition, or a pulmonary condition, or what medications you're taking that might affect your performance. Because it really comes down to you want to have a good time, but you want to be safe.

Leslie Laine: And that then leads up to what should be on your packing checklist, whether you're healthy or if you're not?

Dr. Stone: Well, definitely take a good supply of your pills. I cannot tell you how many times people got delayed and had to have their medicine called in to all over the place. My longest phone call was Juneau, Alaska, when the crews got delayed. So you do want to make sure you have all your pills and a few extra pills in case you get delayed.

Dr. Stone: Taking a few just minor pills, like a Benadryl, unless you run into an allergy, is a good idea, and something for pain. And specifically, if you go to a location that requires special medicine, make sure you talk to your doctor about those special medicines you might need.

Leslie Laine: Are there any simple items that you carry that serve you well for first aid?

Dr. Stone: There is a kit made by QuikClot. QuikClot makes a trauma kit. It has in there something to stop bleeding, it has a trauma gauze, and several other larger bandages. It's not my boo-boo kit. That's if something bad happens kit, so I want a bad happens kit. I also carry blister band aids because the most annoying thing about vacation is when you're walking along, you get a blister, really messes up your fun.

Leslie Laine: I have been advised also to take extra glasses and contacts. Especially if you wear your contacts in the pool.

Dr. Stone: Yeah, right. For those of us who wear daily's, right. We have to bring extras of those, too. Right, but bringing extra glasses is a good idea. And if there's anything special in your equipment. If you're a CPAP user and you need some of those special hoses, you want to make sure you've got all those pieces of equipment they're going to need to take care of it.

Leslie Laine: We should touch on health insurance just briefly. Obviously, if you're traveling in the U. S., you just want to be sure your own health insurance plan will cover you, or how they will cover you where you're going. But when does it make sense to think about health insurance for travel? I'm not talking about trip cancellation, but actually travel health insurance.

Dr. Stone: Yeah, the medical insurance plans, I think, are a wise investment because when something goes bad out of the country, it's 10 times worse. Now you have to deal with a foreign health system, sometimes there's transportation needs. I had a patient, we had to arrange transportation from the Cayman Island back to Hook Airfield, here in Middletown, after he had a femur fracture on a boat. I had a patient in Mexico, who had a vertebral compression fracture and we had to fly him home. So when it comes to those really awful things, when they go bad, they go bad badly, and you want to have that extra insurance to cover those needs.

Leslie Laine: There's so many kinds of trips we can talk about. Let's start with that great American outdoor vacation. So we're hiking, we're rafting, we're zip lining, we sharing space with really big animals. What advice do you have so we can stay safe to enjoy every day? Great out door vacation.

Dr. Stone: So stay hydrated. Most of us in the summertime don't drink enough water and we don't plan to drink enough water. And you really want to make sure that that doesn't become an issue. Because getting dehydrated really messes things up quickly. Bring some food along, you're going to burn some more calories, which is great. But you want to put those calories back in.

Dr. Stone: Otherwise, you're going to burn out half way through the day, and that's a no-fun thing either. In my family we call it hangry, and I think there's plenty of hangry people out there that, you should have had a granola bar in their bag, they'd had a lot more fun.

Leslie Laine: You're just not yourself.

Dr. Stone: You're just not yourself. Avoid wildlife. You want to look at it, but you don't want to come in contact with it. Wild animals are wild animals and they don't want to be petted. They don't want to be loved on. They just want to be left alone. So if you can stay a safe distance from all of the wildlife, I think that's a smart thing to do.

Leslie Laine: I will tell you my quick bison story from Yellowstone, where a man, a bison was walking very close to where a lot of people were. And a man was just standing there with his camera, and the ranger said, "Sir, you need to step back."

Leslie Laine: And the man stepped about four steps back behind this little, tiny railing that divided the sidewalk from the grass, as though he was going to be safe there. And if you've ever been up close to a bison, their head is like as big as half of your car.

Dr. Stone: No, I don't want to mess with those. A lot of dangerous animals are the ones that you wouldn't suspect. A moose is a very dangerous animal. Bison are dangerous. Animals that people think, "Oh, it's just a big pet." No. No, obviously bears, mountain lions, cougars, bobcats, these are animals that don't want to be messed with. And if they come too close to humans, it can become really dangerous.

Dr. Stone: That's why we don't want people to feed those animals. It takes them away from their natural food source, and it makes them think as people as food. We don't want alligators and bears thinking of people as food. When they tell you not to feed those animals, it's really for the safety of the animal and yourself.

Leslie Laine: In some cases, even domestic animals can be something you should stay away from, yes?

Dr. Stone: Inside the United States, most domestic animals have great veterinary care. But outside the United States, they don't have that veterinary care. They don't have those rabies vaccines and other vaccinations, so I would not want to be playing with even cats and dogs in foreign countries, where rabies is much more prevalent, and some pretty awful parasites you'd probably never even heard of. You just don't want to encounter those if you don't have to.

Dr. Stone: My son had an example in Peru. He was on top a mountain and he was approached by a native dog, and he apparently offended this animal in some way, and so the dog rushed at him and bit him on the leg. And we had quite a discussion about his rabies prophylaxis needs at that point, because by the time he got back in country, it was a bit late for that. But you just don't think of dogs as being that dangerous, but in other countries, rabies is a pretty serious risk.

Leslie Laine: We're not going to find any dogs, I think, on cruises. Cruises are very popular. So I'm thinking I don't need to worry about safety on a cruise, except for maybe overindulging at the midnight buffet, right?

Dr. Stone: Well, certainly, that's a big risk. Coming back with more than you came with. One the cruise ship, I mean, obviously, things are very safe. It's a very civilized place, but most of us are going to do excursions. And those excursions are what take us into some pretty remote and sometimes pretty interesting terrain. You may be up on a mountain one day, you may be in a jungle, you're on a beach, you may be in the water, and you have to be prepared for the excursions. I've seen most of my travel injuries and cruises come from the excursion, not from the boat, itself.

Dr. Stone: I've had patients who have, unfortunately, had heat exhaustion when they went out and they didn't bring enough water because I think you're on a cruise ship, you forget to bring your water bottle with you. Patients have eaten food they should not have eaten because they got to the island and there wasn't any food there, so they ate some of the native food. And you want to be careful to avoid food prepared in a small, little hit on the side of a beach. It looks really cool, but it may not be the safest food to eat.

Leslie Laine: So enjoy the cruise, enjoy the buffet, be sensible. But the other thing about cruises, is how many people, amazing number of people on some of these cruise ships. Does that pose an issue?

Dr. Stone: Unfortunately, when five or 6,000 people get together and touch the same object, you're going to pass some diseases back and forth. And particularly a few viruses that are nasty on a cruise ship. We've all heard of those cruise ship diarrhea diseases that, unfortunately, have hit hundreds and sometimes thousands of people. Neurovirus and enterovirus are two of the most common, and the difficult part about those viruses are they're not killed with hand sanitizer.

Dr. Stone: You have to use soap and water. And without proper hand washing, they're going to pass quickly in a cruise ship. So it's one of the things that's kind of difficult to take care of. Recommendations for travelers, in addition to using hand sanitizer to prevent other disease, you may want to use your silverware to eat your food as opposed to eating things with your hands.

Leslie Laine: So if you do see symptoms on a cruise ship, it's probably best to check with the ship's doctor early, rather than wait until it gets problematic.

Dr. Stone: Absolutely. I had the privilege of taking one of those online cruise ship courses, and part of the course was we got to tour the medical facilities, and the staff and physicians were excellent. They have a well-stocked pharmacy, they have a great infirmary. Even a small surgical unit, so facilities onboard most cruise ships are much better than you would think. So if you do get sick, definitely talk to the staff. They're well-suited to take care of you.

Leslie Laine: So while many ships cruise to other countries, millions of Americans fly to destinations as diverse as Berlin and Bali. So if you're traveling overseas, you want to be sure to check the Centers for Disease Control for travel warnings, right. What can you learn there?

Dr. Stone: Center for Disease Control and Prevention has a wonderful site called YellowBook.gov, and they have information on every country in the world. This information is updated regularly and gives travel warnings for updated diseases or outbreaks, like let's say Zika Virus, if you want to know where is that most prevalent. If you go down to the Caribbean you'll see that.

Dr. Stone: If you want to know where the malaria risk is in Africa and where does it stand now, mild, moderate, or high risk. All this information's available to everyone who goes to that website. And most doctors and travel clinics consult this site, as well. So this is where we get most of our up-to-date information.

Leslie Laine: When we're thinking about traveling abroad, when and where should I be concerned about vaccines?

Dr. Stone: So when you think of Canada and Europe, these are all countries just like America, and you don't really need your vaccines updated beyond your typical vaccines in America. But if you're thinking about Central America, and South America, Africa, and some parts of Asia, you really want to make sure your vaccines are up-to-date for the health risks that you're going to find in those areas.

Dr. Stone: And it takes about six months to finish some series of vaccines so you want to give yourself time and you definitely don't want the vaccine before you get onboard the airplane because sometimes vaccines have some mild reactions, like soreness, or stiffness, or low grade fever.

Dr. Stone: And no one wants to travel on an airplane for 12 hours with a low grade fever. So definitely take time before you leave to get those vaccines done. And again, a trip to that website YellowBook.gov will give you what vaccines are recommended. And even as specifically as if you expect to be in an urban area versus being in a more rural area. If you intend to be in a tent versus intend to be in a hotel. They're very specific what they recommend to help travelers stay safe.

Leslie Laine: What advice would you have for a patient who, say is planning a safari?

Dr. Stone: I just spoke to a patient this morning about planning a safari, and it sounds like a wonderful adventure. You're going to see animals you've never seen in environments and terrains you've never been in. But there are some very specific vaccinations and things you want to plan for. Most of Africa, has a malaria warning. In this particular case, the country he was in had a moderate warning. So you need to plan for that with anti-malarial drugs, both before you leave, while you're on the trip, and then when you come back. And you need to finish those because malaria can be quite devastating.

Dr. Stone: There are some specific vaccines you want to take, especially if you're going to be in a rural camp. So if you're going to a city in Africa, that's very different than if you're going to be in a camp. In his case, he was going to be in a camp. And then we planned for some specific prevention strategies, like using promethean to spray his clothing, and using pickerdon, my favorite mosquito repellent to not get bit in the first place. So we did set him up, I think, for a pretty good trip. A few of his vaccines were out-of-date.

Dr. Stone: Most people don't know that vaccines don't last forever. His typhoid shot that he had previously in the last five years, and so he had to get a repeat on his typhoid vaccine. So you want to make sure just because you've had that vaccine once doesn't mean it's good forever. So talk with your doctor specifically about the vaccines you've had.

Leslie Laine: And even though those these sound like relatively exotic vaccines, I can see my primary care doctor for them?

Dr. Stone: Absolutely, because again, we're going to consult those website, but yeah, we've all had experiences where we had to make sure people had the proper vaccines. The big question sometimes comes into, "Can you get the vaccine in a timely fashion?" And there are travel clinics around. Global Health is one here locally that we refer people to. There are specifically, if you're going to go to some parts of South America and Central America, you'll need to have a yellow fever shot. Yellow fever is a legal issue, and some countries will not allow you to enter and will not allow you to even pass through unless you've had that vaccine.

Dr. Stone: So you definitely want to consult Yellow Book to make sure if you need yellow fever vaccine, to go to a certified yellow fever clinic, and have that legal document attached to your passport. Because without it, you won't be allowed in the country.

Leslie Laine: Travel abroad truly is amazing. And especially to the exotic places. But it can also present opportunities to get into trouble. You've seen your fair share, I think.

Dr. Stone: Unfortunately, we know water often is the big area where people get ill. And people forget that when you brush your teeth, you can't use tap water. And my son in India had a great time until he brushed his teeth with tap water and ended up with a pretty bad case of dysentery. And when he came home, he was ... He looked pretty rough. So I would remind people, when you're talking about using water, use filtered water bottles.

Dr. Stone: There are plenty of water bottles out there. Like LifeStraw has a very good filtered water bottle, but there are others that are like it. Or, you can use water purification tablets, but you have to avoid ice because ice is made with natural, local water. And not use water even just to wet your toothbrush.

Leslie Laine: Is that a problem when you're swimming, if you're ingesting water? Have you seen that kind of an issue? Or, does swimming in fresh water, for example, in some Central American country cause a problem?

Dr. Stone: Yeah, often water sources abroad are a source where people dump their sanitation products. And definitely aren't as clean as you would like them to be here in America. I would not put my face in the Amazon River for anything, and I certainly wouldn't want to go under the water completely, and drinking that water would be hazardous to your health. So I think for most Americans, where we're used to clean lakes and rivers, abroad that may not be the case. I would really be cautious about those water sources.

Leslie Laine: What advice do you have for people who do get sick overseas to find the help that you need?

Dr. Stone: The local embassy often has a good list of medical companies or resources available to you because medicine abroad is different than it is here in the United States, and there's not always a public facility. Often, these hospitals are private, and so you need to be referred to one. But the local embassy can give you some ideas.

Dr. Stone: And you can get this information if you look up the country before you leave, and I would recommend looking for a local source of help. I know it's kind of my paranoid part of me, but I always want to know if something does happen, what would I do? So I usually carry that in my information when I fly.

Leslie Laine: Before we go, what one thing would you like us to remember so that we can have a fun and healthy vacation?

Dr. Stone: Hope for the best, plan for the worst. You want to take something along in case something bad happens. I joke, it wards off evil spirits. Have that first aid kid, have that blister band aid, have that preparation ready to go. Hope you never need it, but if you do, you'll go a lot better than having one of those Griswold Family vacations we've come to enjoy watching on TV so much.

Leslie Laine: And we hope they stay on TV and not in our personal lives. We hope you will have an excellent travel adventure, using these great tips from Dr. Matthew Stone, Primary Care Physician with Middletown Family Practice. Thank you so much for taking time to be with us today.

Dr. Stone: Leslie, it's been a pleasure.

Leslie Laine: If you want to know more, visit PremierHealth.com/HealthNow. We'll be back, we hope you will. I'm Leslie Laine and thanks for joining us. Watch for our next edition of Premier Health Now On-Air.