Go Far, Be Well

Whether you travel once a year or once a week, planning ahead to maintain wellness and manage any medical issues that arise on the road can help ensure a safer, more pleasant experience.

By Diana Price

When Jeanine Barone was growing up, travel—even to the beach or a neighboring state—wasn’t an option. “I had what I guess you’d call an underprivileged childhood,” she says. “I went nowhere and saw nothing.” And yet, she says, “I knew there had to be life beyond my house.”

When Jeanine attended college in New York City, she found that wider world and started getting excited about travel. A scientist by training—she received her undergraduate degree in biology and went on to get two master’s degrees, in nutrition and exercise physiology— she became a health and science writer, but soon she was looking for a way to incorporate travel, and her love of exercise, into her writing assignments. So she pitched her editors at major magazines, offering to seek out exercise and adventure stories in far-flung (as well as more local) destinations. Her travel-writing career took off.

Now Jeanine travels regularly as a journalist, reporting on experiences that include everything from mountain biking in Israel, to the schist villages of Portugal, to the coffee culture in Fargo, North Dakota. “I go places that might be known for something—and then I look for something else,” she says of her unorthodox approach. “I call what I do ‘hidden treasure travel, beyond the obvious.’” Jeanine reports for national magazines and newspapers and writes a blog, J the Travel Authority.

When Jeanine travels, health and wellness are central to her planning and preparation: “As I started to travel, I realized that being sick can really ruin a trip. I have a sensitive stomach, and when I began traveling I’d often get sick.” Determined to prevent the discomfort and inconvenience, Jeanine put her scientific background and interest in health to work to make sure illness didn’t impede her wanderlust: “I travel alone a lot, and I like being very independent, so I focused on preventing illness and being safe on the road.”

She researched medical protocols and treatments related to common health issues travelers face and developed a packing list of medical supplies, ultimately creating a collection of small first-aid organizing bags, categorized by ailment (think stomach, ear/nose/throat, and bites/ stings), to ensure that she always had what she—or a traveling companion— might need. Her system proved so popular among fellow travelers that she started selling the system, called Doc-in-a-bag™, on her website. Now Jeanine travels confidently, knowing that she’s prepared and informed to tackle any health issues that arise: “Preventing ills and being safe on the road is what I’m all about.”

Planning—And Packing— For Prevention

Although we may not all travel as frequently as Jeanine does, thinking ahead about your health as you plan a trip is a good idea.

Phyllis Kozarsky, MD, professor of medicine at Emory University and founder of the Emory Travel- Well clinic, is certified in tropical medicine and travel medicine and regularly counsels women about health and travel. Dr. Kozarsky says that an essential first step in any travel planning should be to sit down and consider your basic health needs: “Think about anything you’d need to have—or want to have—on hand to manage routine health problems. Make a list of these items and pack them in your carry-on.”

While it might seem obvious, Dr. Kozarsky says, items to add to the list might include whatever headache medicine you usually take (ibuprofen or acetaminophen), menstrual products (tampons or pads), and birth control. “Many women assume they’ll be able to find these products at their destination,” she says, “but that may not be the case, especially if you’re traveling to a far-flung destination.”

Jeanine advises women to not forget to pack whatever their preferred treatment is for vaginal infections, especially yeast infections, as these are one of the most common health issues for female travelers. “We never think it’s going to happen when we travel,” she says, “but it does, and especially if you’re traveling in a humid climate, where vaginal yeast infections are more common, or when you’re taking an antibiotic.” She notes that the over-the-counter creams and suppositories that many women use at home are helpful, but it’s also worth considering bringing the prescription medication Diflucan® (fluconazole), which can clear up a yeast infection with one oral dose. Also helpful, according to Jeanine, are fragrance-free feminine wipes: “Keeping the vaginal area clean and dry is important to help prevent infections.”

Also essential on the packing list is medication to manage digestive woes. Food-borne illness, specifically diarrhea, is one of the most common issues travelers will face. Dr. Kozarsky advises travelers to bring Imodium® (loperamide), which can relieve symptoms of a mild case; if the issue becomes moderate to severe, an antibiotic may be recommended.

Seek Expert Advice

Understanding the right protocol for preventing issues like stomach trouble is worth discussing with a physician ahead of your trip—one of many reasons why an appointment with an expert in travel medicine makes sense.

Dr. Kozarsky recommends making an appointment with a travel medicine physician four to six weeks before departure. The provider will review your itinerary and current health status to evaluate any special considerations related to travel—age, chronic illness, general fitness as it relates to planned activities, and any anxiety about the trip. With an understanding of your personal health history and needs, the physician can offer tips and preventive strategies and write prescriptions for any antibiotics or other medications you want to take along.

This visit is also a great time to discuss immunizations, Dr. Kozarsky notes, and not only to prevent tropical disease but also to protect against common—and potentially dangerous—illnesses like flu, pneumonia, shingles, and measles. “We focus so much on childhood immunizations, but adults should also be current with any preventive vaccines that provide benefit.”

If your travel plans have you headed to a tropical destination, prevention of insect-borne illnesses will play a central role in your visit. “We’ll discuss which illnesses are present in the country you will be visiting and offer guidance for personal protection,” Dr. Kozarsky says. The Zika virus is the primary concern of most travelers today, especially those of child-bearing age, she says, and a visit with a travel medicine expert can provide the most up-to-date information about this fast-changing story (see sidebar, “Your Best Defense against Zika: Accurate, Timely Information”).

For female travelers specifically, Dr. Kozarsky says, issues related to pregnancy are also important to discuss, especially awareness of due date. “Occasional deliveries still occur on airplanes, which can be a serious problem,” she notes. Also a concern for pregnant women is altitude, not necessarily because of the lower oxygen level but because many high-altitude destinations are in remote areas where obstetrical care is not easily accessible.

For women who aren’t pregnant, consideration should be given to any preexisting gynecologic problems, such as recurrent ovarian cysts. Discussing protection from sexually transmitted diseases may be uncomfortable, but it’s a vital conversation to have. “Unfortunately, the topic is not discussed openly enough,” Dr. Kozarsky says, “but when we look at data we realize it’s a significant problem; statistics reflect the fact that people who travel frequently are more likely to be harboring sexually transmitted diseases and more likely to be transmitting them.” As a woman, she says, the best defense is to carry condoms you’ve purchased at home because the quality of condoms in other countries may not always be as good.

Another important consideration— and one that Dr. Kozarsky says is often not discussed—is anxiety and mental health related to travel. “Paying attention to stress and emotional aspects of travel is really something we, as women, don’t do enough; be sure to discuss any anxiety or stress with your physician.”

Make the Most of Your Travel Opportunities

Chances are good that if you’re planning a vacation, you’ve taken a lot of time to consider transportation, lodging, and activities. Given all that time spent on logistics, don’t you think it’s worth taking time to consider your health so that you can enjoy your vacation and not be sidelined by illness? Taking measures to prevent and plan for management of health issues is an empowering, proactive step you can take toward healthy travel.


Resources on The Road

Even if you’ve taken all the appropriate steps in advance of your trip to safeguard your health, there is no guarantee that you won’t face a medical issue while you’re on the road. Especially if you have an underlying chronic illness, Dr. Kozarsky recommends asking your travel medicine physician for a referral to a provider practicing in your destination city. Or visit the website of the International Society of Travel Medicine (istm.org), which includes a Global Travel Clinic Directory, with contact information for clinics serving travelers around the world.


Best Defense Against Zika: Accurate, Timely Information 

As the Zika virus continues to spread, recommendations related to travel are rapidly evolving. 

“Zika has become one of the most major challenges I’ve faced in the travel medicine field since I began practicing in the 1980s,” says Dr. Kozarsky. “Women who are planning pregnancy, now or in the future, need to factor Zika into their travel planning; we’ve never faced a disease transmitted by insects that has the potential to affect pregnant women the way Zika does.”

The Zika virus is spread when a person is bitten by an infected Aedes species mosquito, through sexual contact with another person infected with Zika, or, rarely, through a blood transfusion and perhaps through other bodily fluids.

According to the Centers for Disease Control and Prevention (CDC), symptoms of the virus are generally fairly mild and include fever, rash, headache, joint pain, conjunctivitis, and muscle pain, and symptoms last several days to a week. The real danger of Zika lies in its impact on a developing fetus; the disease can cause microcephaly, a severe birth defect of the brain.

Because Zika can cause catastrophic damage to a fetus, pregnant women are the most vulnerable population. Unfortunately, Dr. Kozarsky says, “there’s still more unknown than known” about many aspects of the disease: “We don’t know right now how long the virus can stay active in a person’s secretions; we don’t know how long it might be viable in semen; we don’t know how long a couple should wait—what the ‘safe’ window is after they have traveled to a place where Zika is active—before having sex to avoid transmission.”

The bottom line, Dr. Kozarsky says: “Seek counseling from experts in travel medicine and keep up-to-date.” This could mean making an appointment with a physician or reading through the most current information available to travelers, which can be found on the CDC website (cdc.gov/zika). “What’s most important is to have the most current information,” Dr. Kozarsky says.