Managing air travel health hazards

With the approach of summer come plans for travel, including flying long distances.  But the prospect of a long flight often raises health concerns.  Especially for passengers who are older or have certain medical conditions, air travel and its related stress can have an impact on health.

BEFORE YOU GO

Travelers of all ages who are headed out of the country can benefit from a pre-travel visit with their physician at least four to six weeks before an international trip to ensure that any necessary vaccinations can be completed and have time to take effect. Consider meeting with your doctor if you have a chronic health condition, questions about your health status or physical limitations that might affect the trip.

Pack all your medications prescribed specifically for travel and any prescription medications that you take regularly, such as those for high blood pressure, diabetes, arthritis or chronic pain.  Carry all prescription medications in their original containers in your carry-on luggage, in case checked luggage gets lost or is delayed. Take more than enough to last throughout your trip — pack extra to account for travel delays. Bring a copy of all your prescriptions, including both the brand name and the generic names of the medications.

Pack a travel health kit with the following first-aid supplies and over-the-counter medications to help you prevent travel illnesses and take care of minor mishaps that may occur.  Add or subtract items, based on your destination and health status. Large quantities of liquids and gels and sharp objects, such as scissors, aren’t allowed in carry-on luggage.  Be sure to follow restrictions as you pack your travel health kit.

Consider including: adhesive bandages, tape and sterile dressing; alcohol-based hand sanitizer; antacid tablets or heartburn medication; anti-diarrheal medication; antihistamines; cold medication; decongestant; elastic bandage; saline eye drops; fever and pain relief medication; moleskin (soft cotton padding for blisters); scissors or pocket knife that has small scissors (not allowed in carry-on bags); stool softener; and sunscreen with a sun protection factor (SPF) of 30 or higher.

In the event of a medical emergency, carry a card with you that contains basic medical information such as your blood type, drug allergies, contact information for your primary care doctor, and contact information for a relative or friend. Also, carry your health insurance card and a claim form.

WHILE ON THE PLANE

The fastest way to travel — by airplane — is also one of the safest.  Yet by placing you in a pressurized cabin thousands of feet in the air, moving at a speed of hundreds of miles per hour, air travel does subject your body to special challenges. Here are common problems that you might experience.

• Dehydration. The cabin of an airplane has extremely low humidity. This dry environment makes it harder to keep up with your body’s normal fluid loss, increasing the chances that you’ll become dehydrated.  Children, older adults, and people with an illness are most often affected.  Signs of dehydration include dry mouth, lack of tears, little or no urine, and feeling lethargic, fatigued, dizzy or lightheaded.  To prevent dehydration, drink plenty of fluids such as water and fruit juices during your flight. Limit alcohol and caffeine because of their diuretic and dehydrating effects.

• Blood clots.  Sitting in cramped quarters increases your risk of developing potentially dangerous blood clots in your legs.  The problem can happen during any form of travel, but it’s more common on long airplane flights.  Blood clots interfere with normal blood flow, and can break loose and lodge in an artery of your lungs.  To prevent a blood clot from forming:  While in your seat, stretch your legs occasionally and move your feet up and down.  Walk around the cabin every two to three hours.  Drink plenty of water to prevent dehydration. Wear loose, comfortable clothes and shoes. Consider below-the-knee compression stockings, which apply gentle pressure to your leg muscles to help improve blood flow.  Ask your doctor if aspirin might be helpful for you. Small doses of aspirin may help prevent clots. Remember to check with your doctors first — aspirin is not recommended for everyone.

• Motion sickness. Any type of transportation can cause motion sickness. It strikes suddenly, building from a restless feeling into a cold sweat, dizziness, and then vomiting.  Symptoms usually improve as soon as the motion stops.  You may escape motion sickness by planning ahead.  On a plane, try to reserve a seat over the front edge of a wing. Once aboard, direct the air vent toward your face.  If you’re susceptible to motion sickness, these are what you can do: Keep your head still, rested on chair back.  Sleep or lie down.  Breathe plenty of fresh air. Don’t overeat. Avoid spicy foods and alcohol. Dry crackers and carbonated beverages may help settle your stomach. Don’t read. Ask your doctor about an over-the-counter medication such as meclizine (Bonine) or dimenhydrinate (Dramamine).  Expect drowsiness as a side effect. The prescription medication scopolamine (Transderm scop) may also be an option.

• Ear pain. During takeoff and landing, cabin air pressure changes rapidly, disturbing the balance of pressure between the outer ear and the middle ear.  Many people feel pain when the higher pressure stretches the eardrum, the membrane separating the outer and middle ears. The Eustachian tube, which connects the middle ear to the back of the nose and throat, helps equalize the pressure on the eardrum (and causes the welcome pop you feel when the balance is restored). You can help the process by swallowing, chewing gum, yawning, or opening your mouth wide.  A trick called the Valsalva maneuver may also work: Close your nose with your thumb and index finger and exhale gently against a closed mouth.

WHEN YOU ARRIVE AT YOUR DESTINATION

• Jet lag.  Flying across several time zones can disrupt your normal sleep-wake cycles. Until your internal clock adjusts, you’ll find yourself awakening during the night and feeling tired, foggy, and just plain cranky during the day. This out-of-synch feeling is called jet lag.  Your internal clock needs time to adjust — usually one day for every time zone you crossed.  Older adults may have more severe jet lag and need more time to recover. Flying eastward is typically more difficult than flying westward. You may be able to avoid the drag of jet lag by adjusting your schedule a few days before your trip and timing your exposure to bright sunlight. If you’re travelling west, shift your bedtime one to two hours later and seek exposure to bright light in the evening. If you’re traveling east, turn in one to two hours earlier and seek exposure to bright light in the morning. Also, be sure to get an adequate sleep before you leave, rather than staying up late packing.  While traveling, wear comfortable clothes so that you can relax and rest as much as possible on the way.  Avoid alcohol and caffeine, because these substances can interfere with your ability to fall asleep and stay asleep.  Instead, drink water to stay hydrated. Talk to your doctor about whether you should take a sleeping pill. When you arrive at your destination, reset your watch to local time and shift to the local schedule as fast as possible. Again, bright light is your ally in resetting your circardian rhythm.  Go outdoors, sit by a sunny window or turn on the lights at the same time of day you did before departure.

• Traveler’s diarrhea.  This uncomfortable condition is the most common illness affecting international travelers. It’s typically caused by ingesting food or water that’s contaminated with bacteria or viruses, but excitement, anxiety, jet lag, and lack of rest also may contribute to the problem.  Medications that reduce stomach acid, such as ranitidine (Zantac) and the PPIs (such as Losec, Nexium, etc.), also increase the risk of traveler’s diarrhea. This condition often strikes abruptly and causes four to five loose or watery bowel movements each day, sometimes accompanied by nausea, vomiting, abdominal cramps or fever. Most cases of traveler’s diarrhea go away in a day or two without medical treatment. If it hampers your travel plans, you may need antibiotics. Before your trip, ask your doctor about an antibiotic that you can carry with you and take only if needed. Most doctors though, don’t recommend taking medications such as antibiotics or bismuth subsalicylate (Pepto-Bismol in the US) to prevent traveler’s diarrhea except in special circumstances. Instead, preventing traveler’s diarrhea is mostly a matter of hand hygiene and food and water safety. If you’re traveling to a high-risk region, wash your hands frequently and choose your food and drinks carefully. Don’t drink the local tap water and beware of accidental exposure to contaminated water while swimming, showering or brushing your teeth. Drink only bottled water or other bottled beverages or liquids that have been boiled. When it comes to food selections, follow the general rule of thumb: Boil it, cook it, peel it or forget it!

And here are a few extra tips for air travel: If you have a pacemaker, bring a letter from your doctor stating what kind it is and how it’s programmed. You may need this when you go through security. If you have an artificial joint or implanted metal of any kind, you may need to show airline security personnel a letter signed by your doctor, describing its location and purpose.

AFTER YOUR RETURN

Returning home after extended travel may produce unexpected emotional stress. During your trip, you felt stimulated and special, and now, you may be reluctant to let go of the experience. Home may seem dull and demanding. Your relationships with friends may have changed slightly. You’re frustrated by an inability to communicate your true impression of the trip. This may lead to “reverse homesickness,” which includes feelings of alienation, isolation, and depression.

Give yourself time to readjust to normal life. The stimulus of the trip may have given you a new perspective on familiar behaviors that can seem strange or unsettling. Learn to balance these insights with positive aspects of your former lifestyle. Just as you kept an open mind while you traveled, avoid being judgmental and overly critical when you return home. Try finding support from other travelers who may have had to work through similar feelings.

With this information, you are now ready to travel safely. Wishing you bon voyage and healthy traveling!