To be safe in the sun we should have an understanding of how to prevent of skin cancer.  It is also important to know the early signs of skin cancer.

Understanding suncream

Suncream is often applied too thinly – to cover the whole body about an eggcup amount is needed every 2-3 hours. It should also be applied at least 30 minutes before going out into the sun. You should never stay in the sun for excessive periods of time.  Suncream does not offer unlimited protection.

The higher the SPF factor on your cream, the greater the protection against UVB rays which cause burning. Sun cream should be used regularly and in proper proportions, especially in a tropical climate. A high SPF factor will only help prevent burning – it will not always protect against UVA rays, which are not taken into account when calculating the SPF. UVA protection is usually rated separately between 2 and 4.

Using clothing to protect you in the sun

It is important when travelling to understand the risks associated with too much sun exposure. This is true not only on the beach. Snow, sand and water will also reflect the sun’s rays. Our choice of clothing can play a part in protecting our bodies.

Wear clothes that will protect you in the sun – sunglasses, clothing of tightly woven fabric and a sun hat covering the neck, ears and back of the neck.

Protection through lifestyle

Here in the UK we still consider a good tan to be “fashionable” and let’s face it who doesn’t feel better about themselves when they have developed a tan! However simple lifestyle changes as well as “everything in moderation” can help us lower our risk of skin cancer.

Staying in the shade between 11.00 and 15.00 hrs you can help prevent burning and overexposure. Too much exposure even in the UK can eventually lead to skin cancer, ageing, wrinkles or sunburn. When you arrive at your destination don’t sit out in the heat all for the whole time on the first day – gradual exposure to the sun is far safer, increasing your time as you get used to the sun.

Drink plenty of non-alcoholic drinks to prevent dehydration. If you are on any medication check with your doctor before you go away as some medications can make you more sensitive to the sun.

Keep an eye on those moles when you have been in the sun

Always consult with your Doctor or Nurse if you notice any unusual changes in your skin or your moles. Any moles which become itchy or bleed, or change in colour, shape or size should also be reported to your doctor.

Resources

• What do the experts actually say about Viagra and the increased risk of melanoma – read the real story from Harvard Medical School
• Cancer Research UK helps you understand your moles and risk of melanoma 
• The Telegraph has a good article to help you understand how to read a suncream label

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

What is Travel Related Deep Vein Thrombosis (DVT)?

A Deep Vein Thrombosis (DVT) is a clotting of the blood in any of the deep veins.  This clotting is usually in the calf. If a clot develops, it usually makes its presence known by an intense pain in the affected calf. Medical attention should be sought immediately if this occurs, especially after a long journey. In some cases this can be fatal. If the clot breaks off and makes its way to the lungs it can then affect the lung’s ability to take in oxygen.

What are the symptoms of DVT – How will I know it is a DVT?

A DVT can occur days or even weeks after a trip. In most situations the person will have no symptoms. In many cases through normal movement the clot will break up.

If the clot is larger it can cause an obstruction and prevent the blood flowing through the veins. When this happens a person might experience pain, redness and swelling in the affected area.  The affected part of the body might also ache and the skin might be warm to touch.  The pain might also feel worse when walking or standing. If these symptoms are experienced urgent medical help is required.

Complications can occur if the cot breaks off and travels to the lungs. If a clot breaks off and travels to the lungs the flow of blood can become blocked. Breathlessness and chest pain can occur hours or days after the clot has formed. This is a potentially fatal condition and urgent medical attention is required.

Who is at risk of DVT?

We  have a lot of information from hospital research specific to DVT. We already know that immobility for an extended period of time can increase the risk of DVT with the following factors being added risk factors:

• A personal or family history of DVT
• Active cancer or cancer treatment
• Recent surgery or leg surgery
• Existing clotting abnormality
• Obesity
• Hormones or the oral contraceptive pill
• Inflammatory bowel disease
• Varicose veins
• Pregnancy or 2 months post-partum
• Existing Cardiac problems or a history of cardiac problems or stroke
• Dehydration
• Severe infection
• Aged over 60

How many people get a DVT?

It is hard to establish just how many people are affected by DVT after travel related activities, as no official records are kept. However it is important to be aware that it is a potential problem for those with risk factors.

How can I prevent DVT when travelling?

Those in a high-risk category should see their travel health advisor or doctor before they travel and discuss prevention.

Those at risk should try to exercise at least every hour on long journeys. Exercise the calf muscles by rotating your ankles, or making use of the commercially available exercise equipment. The risk applies to any form of travel where you are routed to one place for hours at the time.

Good compression hosiery will encourage circulation. However it is important that you do not wear clothing that will cause a restriction of circulation. Any compression hosiery should be measured properly to ensure a suitable fit.

For long flights wear loose clothing. Due to the change in atmospheric pressure in a plane, parts of your body can expand due to increased gas! In the dry environment of a plane, it is a well-documented fact that too much alcohol, tea and coffee on flights can add to the problem of dehydration. It is therefore very important to remain hydrated during a long flight by drinking plenty of water and fruit juices.

Always remember to buy your travel insurance before travel. For travel within Europe (EEA and Switzerland) you can also get a free European Health Insurance Card.  When planning a trip take a look at the Pre-Travel Advice to ensure you are fully prepared for a healthy trip.

In-Flight Stockings, Compression Hosiery and DVT Socks

With much attention given over the potential risks associated with Travel Related Deep Vein Thrombosis, it is not surprising that many people are looking for products, which will offer protection. Research has shown that correctly fitting anti-thrombosis stockings or DVT socks increase blood flow, thus lowering the risk of DVT in those at risk. Advice related to stocking/socks should apply to all forms of travel when a passenger is sitting still for a long period of time.

Assess your risk of DVT

• Before buying any products assess your personal risk factors and obtain advice from your own doctor regarding fitness to fly. If you are in a high-risk category you should seek advice from your doctor and consider postponing your travel plans

Get measured properly by a professional

• It is important that any DVT stocking/sock purchased be fitted properly by a professional. A stocking that is too tight and worn by a traveller with existing circulation problems can do more harm than good — cutting into the skin on a long flight and potentially causing ulceration and increased risk of DVT
• Never guess the size stocking or sock you require – ask to be measured properly. A good flight sock will come in a variety of sizes allowing for measurement from the knee to the ankle as well as the foot size. If a stocking is too tight around the knee it will prevent essential venous return causing the blood to pool around the knee.
• When buying your DVT compression hosiery make sure they are comfortable with your chosen footwear for travelling. Some flight stockings can be slightly thicker than normal leg covering and can be potentially restrictive with tight foot wear.
• Do not think that if you wear tight knee-highs during a flight you will save some money. Any clothing or tight shoes cutting into the skin around will prevent normal blood flow and increase the risk of travel related DVT.
• Wear your stockings around the house prior to travel to ensure you have a good, comfortable fitting. On the morning of your travel put them on when you get dressed, especially if you are travelling a distance to the airport. Hurriedly put on stockings in the airport lounge can cause no end of travel related anxiety!
• Flight socks and stockings are just one-way to help prevent travel related DVT – take advice from your doctor as well as preventative advice related to travel.

What can your Doctor, Nurse or Pharmacist do to help?

Your Health professional will be able to help you determine your risk factors and provide you with both advice and written information. They will also be able to guide you as to the best time to travel after an illness or operation.

Other Resources

• Information provided by the Civil Aviation Authority can help you check your fitness to fly
• The World Health Organisation have provided information about the risks of air travel
• Virgin Atlantic in-flight exercises can help you stay flexible while flying
• VR Compression (based in London) can provide individual help to travellers at risk of DVT

• If you have travelled to a malaria zone, you should wait for 12 months before giving blood, unless you have had a malaria antibody test, which has proved negative to malaria.
• If you have visited Central or South America at any time, you should advise your blood bank prior to giving blood.
• If after travel, you have any disease or undiagnosed illness related to your travels you might be advised not to give blood.
• Any person who has travelled to the United States or Canada between 30th June and 30th November might not be able to give blood for 28 days due to the risk of West Nile Virus
• For more information on becoming a blood donor, contact the National Blood Service.

  

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

Pre-travel planning and good control are the most important aspects of travel for the asthmatic traveller.

Sort out your supplies and equipment

Get your GP to write a letter confirming that you are an asthmatic, along with a prescription for your medication, enough for the trip, and a bit more. A letter from your GP, listing your medication, will help in an emergency. Also discuss with your asthma specialist a plan of action for you to follow should your asthma become more severe while you are away. You will need a record of which medication you need to take and when it is advisable to seek medical advice. Your medication should be suitable for the worst attack you have ever had.

Carry your inhalers with you at all times and keep a spare one in your hotel room or accommodation. If you feel unwell, take regular peak flow readings and compare this to your normal rate. It is important that you seek medical attention if your condition deteriorates while you are away.

Identification

You might also want to purchase some Identification with your asthmatic information on.

Research your destination

Do some research into the location you are travelling to regarding pollution in the area; pollution in some cities around the world can easily initiate an asthma attack. Look into the availability of English speaking doctors in the area, should you need to seek medical attention.

Scuba-diving

The desire to dip into cool water after a busy day can be enticing to anyone. Along with abiding by normal diving rules, asthmatics should not dive for 48 hours after a wheezing attack, however mild that attack might be.

High altitude

Asthma can be unpredictable when travelling to a high altitude – some people away from the allergens and dust find they have no problems, while others find their asthma is worse in the cold, dry air.

Acute Mountain Sickness (AMS) can affect anyone travelling to a high altitude (above 3000 meters) and holds no extra risk to the controlled asthmatic. However, an asthma attack as well as AMS will greatly increase the risks involved. You should carry inhalers with you at all times, however ‘mild’ you may consider your condition.

Allergies

If you are aware of certain allergies, such as feathers in pillows, inform your hotel ahead of time so that your accommodation can be prepared in advance.

If you are known to also develop serious reactions to insect bites, stings or nuts, discuss with your doctor the possibility of taking an Epipen with you along with a letter explaining its use for medical emergencies.

 

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

Plan Ahead

It is important to think through your trip. Research your destination carefully and think through the practicalities of how long you plan to be away, and what kind of activities you plan to take part in – will you be more or less active than you normally are at home? And what about food, do you easily adapt to other foods or will you have a hard time finding something you like to eat?

• Visit your GP or diabetic advisor in good time to sort out your supplies and equipment –
• A letter from your GP confirming you are a diabetic, and why you have needles in your possession, would be a good idea!
• Make sure you get a prescription for your medication, enough for the trip and a bit more.
• Purchasing a diabetic identity bracelet gives some travellers the piece of mind they need when travelling, as does having medications listed for emergency situations.
• Immunisations and anti-malaria medication are usually safe for the diabetic, and should be discussed with your doctor.
• Insurance is best sorted out as soon as possible and the wise traveller will shop around. It is important to mention your diabetes as a pre-existing condition. Ask at Diabetes UK if you need help in finding a good policy. Excellent guides can also be purchased at Diabetes UK, giving you specific country prescription regulations. As well as good insurance, you will also need an EHIC if you are travelling within Europe.

Travelling with Insulin

• When you travel by air it is not always necessary to order “diabetic meals”. Check your carbohydrate intake regularly and, if required, top-up with snacks on the journey.
• When travelling by air don’t be afraid to ask a flight attendant for more food or a slice of bread if you need it. When you are about to eat on a flight, don’t take your insulin until you see the food coming down the isle – all kinds of things can cause a hold up or delay in it getting to you!
• If you are travelling into unknown territories, take plenty of snacks, especially if you are backpacking and are unsure of your final destination details. The journey might take longer than you planned, and the McDonalds you thought would be on every corner, might not be there!
• Always keep your insulin with you at all times. Insulin should always be carried in your hand luggage, out of direct sunlight or freezing conditions – such as an aeroplane hold! If your insulin comes in U-100 check the conversion rate in countries where it comes in U-40 or U-80. It will be essential in this situation to get new syringes to avoid dosage mistakes. Travel to tropical regions of the world will require you keeping the insulin in a cold pack, or in a cool place, maybe next to a cold water bottle.
• Heat will affect the rate at which insulin is absorbed. In the heat, insulin is absorbed quicker. It is therefore important to monitor your levels in hot weather and adjust your diet as required.
• In a cold climate insulin is absorbed slower. Also if you find yourself cold and shivering it is possible to use up energy and lower your blood sugar levels. Monitor your blood sugar levels in extreme conditions and never let your insulin freeze.
• Adjust your insulin times when you reach your destination – you will have already discussed this with your diabetic adviser but just to remind you:
• When travelling WEST lengthen the gap between insulin doses or add extra food with an extra dose until adjusted. When travelling EAST shorten the gap and reduce dosages. Always check your blood sugar at regular intervals when you cross time zones, as you might need to adjust your dosages. Remember perfect control might not be possible in the first few days, but keep working at it.

Arriving at your Destination

Finally arriving at your destination is a very exciting time – make sure you have pre-booked a hotel for the first few nights if you are backpacking, so that you have time to readjust to your surroundings before setting off.

It is inevitable that on some days you might not feel yourself, either because you are adjusting to different food, or because you have caught a local stomach upset which has left you a little green! Traveller’s diarrhoea is often a case of “when” rather than “if” in most tropical destinations, and careful attention should be given to food and water. It is important to monitor your blood sugar levels carefully while you are sick. Maintain a good level of carbohydrate content in your diet and don’t delay seeing a doctor if the problem continues or if you are worried about your condition.

  

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

Plan Ahead

Visit your GP or specialist nurse as soon as you can to get repeat prescriptions — get enough for the trip and a bit extra. To make it easier when you go through customs, get your GP to write a letter if you need to carry equipment or needles with you.

Malaria and Vaccinations

Disabilities do not stop you taking malaria medication or having vaccinations if they are recommended for your destination, unless you have contra-indications to them. Sort these out with your Travel Health Specialist as soon as possible.

Transport Needs

Plan ahead – inform the airline or travel operators of your needs. They are used to providing special chairs, seats or meals, so do not feel you are ‘putting them out’ – it is their job to help you and make your trip as safe and comfortable as possible.

Choose your method of transport with care, and when flying, go with the most direct route so that you are not left trying to change flights at numerous locations around the world. Discuss with the airline if you will need any assistance.

Look into international organisations that can help with your particular needs. A search of the Internet can bring up all kinds of organisations — there is even an organisation dedicated to providing a dialysis network in certain countries. Choose good insurance with a company that is aware of your condition. If you are travelling with a companion, make sure they are aware of their role in helping you prior to leaving.

If you have a hearing disability, inform the flight attendant so that alternative safety instructions can be given to you.

Returning Home

When you return home, see your GP for a medical check up, especially if you have been ill while away.

  

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

Vaccinations

Many countries require vaccination, some of which may not be advisable to have during the first trimester of pregnancy. If it is essential that you travel to a destination where Yellow Fever vaccination is required, talk to your doctor about a certificate of exemption.

Malaria

If it is essential that you travel to a malarial area, medication may be required. Discuss with your Doctor the most suitable medication for you at this time. Folic acid supplements are sometimes recommended with certain anti-malarial tablets.

Insurance

Make sure that your insurance covers your ‘pre-existing’ condition, should any unforeseen problems arise.

The Journey

If you will be immobile while travelling, such as on a coach or in a plane, it is important to recognise the added risk of DVT. If you have more risk factors aside from pregnancy, you should see your doctor before you travel and discuss prevention.

Try to exercise at least every hour on long journeys. Exercise the calf muscles by rotating your ankles, or making use of the commercially available exercise equipment.

It is important that you do not wear clothing that will cause a restriction of circulation.

Wear loose clothing. Especially when flying – due to the change in atmospheric pressure in a plane parts of your body can expand due to increased gas!

Avoid dehydration. In the dry environment of a plane, it is a well-documented fact that too much alcohol, tea and coffee on flights can add to the problem of dehydration. It is therefore very important to remain hydrated during a long flight by drinking plenty of water and fruit juices.

At your Destination

If you are planning an extended stay abroad, remember that some airlines will not allow you to fly after 36 weeks on domestic flights, and 34-35 weeks on international routes.

Care should be taken in avoiding stomach problems by watching what you eat and drink. Advice should also be considered in relation to sun care, sexual health and preventing bites, especially in high risk malarial destinations.

  

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

A Medical Tourist is a person who travels abroad for specific medical treatment or alternative therapy to restore their health as well as allow them to experience local culture. Among the most popular treatments are dental and cosmetic surgeries.

Why do people go overseas for medical care?

The Medical Tourism Survey found that more than 50,000 people travelled from the UK to an overseas destination for medical treatment at a cost of £161 million in early 2007. From those going overseas from the UK, concerns about increasing rates of MRSA, long NHS waiting lists and the promise of cheap medical treatment abroad were main reasons.

What Medical Tourism is not…

Medical tourism does not include those patients who have requested permission from their existing health commission for treatment in Europe. There are currently two ways to get treated overseas under the NHS.

European Union regulations of article 49

Under these guidelines a patient can receive treatment in another European country as long as it is the same as they would have had in the UK. Treatment can be at a private hospital or a state funded hospital. Patients will need to pay for the treatment received up front when they are treated. As long as the care is approved they can seek reimbursement, but this might not be the total cost of treatment. Reimbursement is however not automatic and requires approval from a patients own healthcare trust prior to treatment. Under these circumstances a patient is not covered on a European Health Insurance Card (EHIC)

E112 Form

This route allows you to have treatment in another state funded sector hospital within Europe (EEA) and Switzerland. You will need to make payments in the same way that a local person seeking treatment would – this usually involves a percentage of the costs up front. Payment for the remainder of the treatment is made via the NHS and if there is a difference based on your up front costs you can seek reimbursement.

For each of these routes permission must be sought from your local Primary Care Trust or GP first. The Department of Health website gives a full list of conditions and guidelines.

What Travel Health advice do you need if you decide to go overseas for independent medical treatment?

All economic predictions suggest that medical tourism will increase over the next few years. It is essential if you decide this is the best option for you that you are properly prepared and receive safe care.

Insurance

Medical tourists should be aware that a regular travel insurance policy used for holidays and business trips will not cover you when going overseas for medical treatment. This also means not having cover in the event of anything going wrong with their surgery or, in most cases, even for lost luggage. This is due to a blanket clause on most policies stating that cover is no longer valid if the “primary purpose” of the trip is to receive medical treatment. If you are considering going overseas it is important to think through what you will do should something go wrong with the surgery and discuss this with your insurance provider and relatives before you travel.

Immunisation and Malaria Advice

Advice should still be given by your doctor or travel clinic nurse for the destination you are going to visit. You will also need to consider the recuperation period after treatment and your health risks. For countries where blood borne diseases such as Hepatitis B are endemic it is worth considering vaccination. It is important to remember that disease and malarial mosquitoes have no respect for hospital boundaries. Even in the holiday period after treatment you could be vulnerable to local infections and potential respiratory problems following surgery.

Blood Group

Make sure you know your blood group and for some parts of the world research and discuss with your treatment supplier how you will be able to access a safe supply of blood.

Fitness to Fly

You will need to ensure that you are fit not only to fly to your destination but back again. Certain types of surgery will require longer recuperation and you should allow plenty of recovery time prior to the return journey. Most abdominal or ear surgery requires a ten day wait prior to flying without complications, whereas keyhole surgery recommends a four to five day wait. You should also discuss with your GP the prevention of DVT and consider your risk factors.

NHS on Return?

If you are planning on going overseas as a medical tourist it is a good idea to discuss your pending treatment with your GP and consider if you will be able to receive any follow up treatment in the UK on return. Important follow up care is not included in a health tourism package. The importance of returning with detailed medical notes is essential if you are to receive continuity of care.

More Information and Resources

If you have insurance concerns prior to travel you should contact the British Insurance Brokers association on 0901 8140015 for advice.

Medical Tourism: Your Complete Guide to Low-Cost Dental, Cosmetic, Medical Care & Surgery Overseas by Paul Gahlinger (2008) is a complete reference to treatment overseas

The Complete Medical Tourist by David Hancock (2006) gives an overview of treatment overseas looking at costs, locations, procedures and sightseeing.

NOTE: We have not included any links to Health Tourism companies in the above article, but do have advertisement links on this page to raise revenue for updating the site – it is essential that you research any Health Tourism Company offering such a service.

It is important to remember that you are in a potentially vulnerable position and you should do your homework before considering such a venture. It is also essential that you visit your health care provider or GP to discuss your plans.

  

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.

From the corporate Business Traveller to the low budget sole trader, health shows no respect for status or expense accounts. There are no stereotypical Business Travellers.

BusinessTravelHealth.com seeks to recognise your diverse needs as a Business Traveller. It offers a practical common sense approach to meeting those needs through good preparation and access to information. It identifies the different mindsets with which individuals travel and seeks to provide you with advice and motivation to protect your health wherever the wind may take you…

Health Advice for Business Travellers

This section suggests practical ways to maintain your health while you are away from home. Not all health incidents relate to disease — there is the matter of preventing accidents, issues of personal safety, dealing with travel stress, and more…

Disease Prevention

Illness affects most business travellers on one trip or another. If you travel to tropical destinations, the diseases may be less familiar than if you travel within the western world, but the risks remain.

With only 5% of all travel related health risks preventable by vaccination, it is essential to understand how the prevent getting sick. This section provides insight into the diseases at your destination, as well as how to prevent infection with practical precautions.

Resources and Tools

There are a large number of very useful tools available to the business traveller to help prepare for a trip. We have compiled a selection of books, articles and useful online tools that are well worth a click.

  

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Note: This information is designed to complement and not replace the relationship that exists with your existing family doctor or travel health professional.  Please discuss your travel health requirements with your regular family doctor or practice nurse.