Be prepared for travel

I have updated and am republishing the following blog post as it remains pertinent and should stay top of mind. Please send any questions to me in the comments and feel free to share your own tips there as well.

Planning your trip of a lifetime? Or just a short getaway in a far away place. Or even not so far away? So many things to do to get ready. Get the passport, talk with your travel agent, pack your bags, etc. Unfortunately, we too often forget one of the most important aspects of travel preparation, a trip to your doctor.

Depending on your age, overall health and travel destination, this may be a very short or a very long visit. You may need to just make sure your health has not changed enough to make your trip hazardous for you or your companions. On a trip abroad or one in which significant strain will be placed on your body, this may be a much more detailed exam and might entail an hour or more of you and your doctor’s time. With all these variables, how can the lay person know when, or if, they need to see their doctor? I want to give you a few hints to help you decide.

Start by thinking about your overall health. Regardless of where you are going and what you plan to do, if you have a great many health issues, you will want to stop by your doctor’s office on the way out of town. You will want to be sure you have refills on all your medications to avoid the situation of being in a new town without your medication and no way to get a re-supply. It is also not a bad idea to have your doctor give you what is often referred to as a “chart summary” about your medical health. Primarily, this summary will consist of all of your diagnoses, your medications, past surgeries, family and social history, as well as vaccination status. These are especially easy to do if your doctor has an electronic medical record (EMR or EHR). This system will often generate the note with little or no input from the doctor. If he or she is still using paper charts, this may be somewhat more cumbersome to get together. These summaries are often free. However, with the old paper charts, you may have to pay extra for the time it will take to prepare. You can also do this yourself (if you can remember all of this information). However, in a situation where you are unable to speak for yourself, providing the local providers in the country you are visiting with this information in an “official” document may carry more weight than your own hand written information. These summaries can be invaluable in situations where your diagnosis is very specific and time is of the essence. It could save you from undergoing unnecessary and even dangerous procedures in an unfamiliar setting. At this visit, you will also want to ensure that you are up to date on all your preventative screenings, vaccines and follow-ups for all of your regular health problems. Be warned, this may include blood work. So go fasting for at least 8 hours prior to the exam and be prepared to have blood drawn. You will also want to read over the next several paragraphs for additional reasons to make a doctor’s appointment and more helpful hints.

For those of you who are in the prime of life and at the peak of health, a visit to the doctor may seem a waste of time and money. However, even the most healthy individual may need some “fine-tuning” to ensure the greatest chances of a happy and successful adventure. We all get sick occasionally. That “tickle” in the back of your throat might turn out to be strep throat or a sinus infection in need of treatment prior to an airplane ride. There is nothing worse than ear pain from fluid behind your ear drum on take off or landing. You may need to discuss your vaccination status, depending on where you plan to travel, as well. If you plan on traveling to a country requiring yellow fever vaccination, you will not be permitted out of the airport without the appropriate yellow card. Not much fun to spend thousand of dollars and days of travel just to visit a far away airport! You might also mention to your doctor what your exact travel plans are. Mentioning that you plan to spend several days diving, to include the morning of departure and then getting on a plane to travel back, should bring a worried response from your physician (Google “the bends” for more information). While you should get this information before or during your scuba adventure, it may be too late to reschedule your return flight and you may have to forego the final sessions of your underwater adventure.

Now that I’ve convinced you to head to your doctor’s office on the way out of town, let’s talk about how to prepare yourself and your doctor for your visit. When scheduling, make sure you let the receptionist know you are coming for a travel consult. If possible, give them a week or more notice to fully prepare for your visit. They may not need this time if you are not going out of the country or if they are used to such visits. In many clinics, however, this may not be the routine and showing up with no prior warning and planning to head to the airport in the next day or so, may not be the most convenient for you or your doctor. You, as the patient, also need to have done your homework. This means heading to the Internet to research what tests, vaccines, permits, etc. you may need. Again, if your doctor does not routinely do this type of visit, he or she may not be familiar with all that you will need and will have to quickly do the research (and possibly misinform you). You might also find that your doctor doesn’t do this type of visit at all. Again, you don’t want to find this out right before your trip and be without a back-up plan.

Once you have your appointment, do your own homework and print everything out. You may even want to drop this information off with your doctor for review prior to your appointment. This is important to ensure that you are both well informed and “on the same page”. If your Internet search is faulty, this will allow your doctor to give you correct information in a timely manner. Prior to your visit, you will also want to check with your insurance company and the doctor’s office to see how this visit will be paid for. Many insurances will not cover such an exam and you will be expected to pay at or prior to the time of the visit. This is also important when it comes to any vaccines or prophylactic medications you may need to take prior to, during, or even after, your trip. There may be several options on vaccines or medications and you want to know, beforehand, which one(s) you are desirous of taking. There can be differences in cost, time to onset, total time needed to take, insurance coverage and side effects that you want to know about. The drug that may be the most convenient for you and your doctor may be out of your price range. Alternatively, the drug covered by your insurance may come with worse side effects or take too long to get into your system to be effective prior to your trip, thus making it ineffective or undesirable for your particular situation. Your doctor will need your help in determining what medication(s) will be best for you. If you are wanting to get all vaccines and prescriptions done in one visit, you will also need to make sure your doctor stocks these medications. Often, a prescription will have to be written and a return visit for the shot made. Again, timing is important to ensure you are able to get your vaccines, etc. in a timely manner. So, the more information you can provide your medical provider the better.

Of course, there is not enough room here to cover every possible medical scenario that you might have. Below, I am going to list a few resources and other, more general tips that may help you in your travels. If you have any specific questions, feel free to leave them in the comments section. Happy travels!

1. If you are on any narcotic pain medications or “Psychotropic Substances” (especially for foreign travel), you will want to have an original copy of your prescription. You can check the website of the International Narcotics Board at http://www.incb.org to see if your medication falls into this category.

2. You will also want to make sure that all of your medications are stored in their original containers with legible labels. Many people chose to place their medications into weekly planners to ensure they take them as directed. However, having a container of unlabeled pills at the Customs counter may lead to significant difficulties going into and out of many countries around the world.

3. The Center For Disease Control’s website at http://www.cdc.gov contains valuable information regarding vaccines, prophylactic medications and travel advisories.

4. You can also check out the State Department website at http://www.state.gov for travel advisories and warnings.

5. If traveling to an area where travelers diarrhea is endemic, ask your doctor for prescriptions for Azithromycin, flagyl and lomotil (assuming no contraindications). Of course, he or she may want to alter these options depending on your allergy profile and will need to instruct you on their proper use.

6. In many countries, medications only available with a doctors prescription in the US, may be available over the counter. Before you panic, make a trip to the local pharmacy to see what you can find. You must be aware, however, that drug names vary from country to country and you have to be certain of what you are taking.

7. You may want to check out one of the many insurance companies that provide for overseas or out of country care. Should you have a life threatening event, many will fly you back to the US for definitive treatment. Or, they will ensure you receive quality care in the foreign country.

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