Monday, March 13

When Moctezuma Gets His

By Dr. Roberto Moreno

The month of March has arrived and its time to pick that spring break trip again. Whats it going to be this year? Moguls or jungles? Lift lines or bikini lines? While the brown bottle flu may be the only illness most people will encounter, this column will offer disease prevention tips to anyone brave enough to venture south of the border or to any country where you will be exposed to different foods, customs and microorganisms. Although the threat of disease is always present, these suggestions, if followed carefully, may minimize your risk and aid you in getting every pennies worth of estas vaciones estupendas (that ultimate vacation).

Vacunas (Immunizations)
All vaccinations should be up to date and should include the following:

1) Measles, Mumps, Rubella (MMR). Two doses given to people born after 1956 who havent had physician documented cases of the diseases.

2) Diptheria, Pertussis, Tetanus (DPT). A booster shot is needed every ten years.

3) Polio

4) Tuberculosis

5) Typhoid Fever. A booster shot is given every five years.

6) Hepatitis A. Is recommended for travelers going anywhere outside the USA, Canada, Western Europe, Japan, Australia or New Zealand. It is a single shot followed by a booster 6 to 18 months later.

Diarrea (Diarrhea)
Travelers diarrhea la venganza de Moctezuma (Moctezumas revenge) is by far the most common medical problem among people travelling internationally. It is defined as the passage of at least three unformed stools in a 24-hour period together with nausea, vomiting, abdominal pain, fecal urgency or the passage of blood or mucous. This should also include the same symptoms during the first 7 to 10 days after returning home. The disease usually lasts 3 to 5 days and is caused by exposure to virus and bacteria to which our bodies are unaccustomedthe principle agent being a tiny bug called Escherichia coli. Although its occurrence is far greater when traveling to tropical and semi-tropical countrieswhere crops are sometimes grown in soil fertilized with human wasteresidents of underdeveloped countries are not immune to the illness when visiting the more-technical-than-though world. They often encounter a milder form of travelers diarrhea which has been termed el imperio contra ataca (the empire strikes back).

1) Prevencion (Prevention). Eyeing that salsa? Ready to dig into that salad because youre too hungry to wait for your entrie? Whoa, boy! Back off Jack! Hay peligro en la comida (thars danger in that thar food). To prevent travelers diarrhea, it is imperative that you eat only thoroughly cooked food, or fruits and vegetables that you have peeled yourself. Avoid milk and milk products (cheese, ice cream, yogurt), custards, cream pastries, mayonnaise and salad dressings. Drink only beverages from cans or bottles. Completely stay away from ice cubes and tap water, even when brushing your teeth (water can be made safe by boiling it or filtering and adding Iodine tablets). You should also wash your hands often with soap and water. Remember, hiervelo, cocinalo, pelalo o olvidalo! (boil it, cook it, peel it or forget it).

2) Profilaxis (Prophylaxis) . This is not recommended unless you have active inflammatory bowel disease (Crohns disease or idiopathic ulcerative colitis) insulin dependant diabetes, heart disease or AIDS. See your physician if you suffer from any of the aforementioned prior to traveling.

3) Tratamiento (Treatment) . It works with plenty of fluids, food and saltine crackers. Bismuth subsalicylate (PeptoBismal) two tablets four times daily is recommended with the first sign of loose stools. If symptoms persist beyond 24 hours then Loperamide hydrochloride (Imodium), an over the counter synthetic opiod, should be taken as 4 mg initially then 2 mg orally after each loose stool, to a maximum of 16 mg a day. If a fever, severe abdominal pain or bloody feces are present, then antibacterial therapy is recommended, usually with Ciprofloxacin, and should relieve symptoms within 24 hours.

Colera (Cholera)
The risk to tourists is very low unless, you are traveling to Africa, underdeveloped countries in South America or east or Southeast Asia. Outbreaks occur when exposed to contaminated water, primarily during the rainy season when the sewage systems overflow, but can also be spread through human contact. The vaccine for travelers has minimal effectiveness and isnt recommended. Careful hygiene is the only protection against cholera.

Paludismo (Malaria)
Malaria is a preventable infection that is carried by mosquitoes and can be fatal if left untreated. It has been eradicated in the US and other industrialized countries for several decades. This disease can be avoided by antimalaria drugs and by protecting yourself from mosquito bites. Resistance to medications varies in different geographical areas of the world. If you think you may be traveling to an area where you will be at risk for malaria infection, call the Malaria Branch of the Center for Disease Control at 770-488-7788, for recommendations on malaria prevention.

Puedo Decir Un Consejo A Los Prudentes (A Word To The Wise)
Tu medico a consejo siempre antes de viajar a los paises en vias de desarrollo (Always consult with your doctor before traveling to developing countries).

Andale!

Roberto Moreno M.D.