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When vacations make you sick

Ready for the vacation of a lifetime?

Pack your swimsuit and your dancing shoes. And don't forget the ibuprofen, cough medicine, decongestant, antibiotic ointment, seasick medicine, anti-diarrheal, antihistamines, antacid, aspirin, Larium for malaria and EpiPen, an emergency injection of epinephrine for severe allergic reactions.

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Because chances are you're going to get sick on your vacation.

Even getting there and back can be hazardous to your health. Maryann DellaRocco, 33, developed vertigo coming back from a trip to the Bahamas.

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"I was told by my doctor that one of my ears just decided to give up," says the software tester, who lives in Elkridge, "probably from the air and sea travel."

When she got home she had to stay flat on her back for three weeks. She still sometimes has bouts of vertigo and can't tolerate loud noises as well as she used to.

Travelers have long believed that they're likely to pick up a cold or flu bug from breathing the recycled air of an airplane, not to mention getting dehydrated because the air is thinner and drier. Dr. Elaine Jong, clinical professor of medicine at the University of Washington and a pioneer in the growing specialty of travel medicine, recommends carrying protective face masks on a plane. Not to wear, but to give to other travelers who are coughing or sneezing.

"But then I'm fairly assertive," she says.

The next new thing to worry about when you fly is the recently named Economy Class Syndrome, so called because blood clots could form in your leg during long, cramped flights.

Take a cruise and you risk an intestinal Norwalk virus infection (probably from those raw oysters on the seafood buffet) or, at the very least, seasickness.

If you're getting away from it all by trekking in the Himalayas, we have two words for you:

Altitude sickness.

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Risk is everywhere

A luxury vacation to Europe could result in a bout of traveler's diarrhea if you're not careful, and maybe even if you are. Stay in the United States and go camping, and you have to worry about West Nile virus from the mosquitoes and Lyme disease from the ticks. (Better pack a bug spray with DEET.)

Those who are heading for Toronto or Hong Kong are thinking about SARS, no matter what the World Health Organization says. Visit a Third World country and there's a chance of contracting everything from viral hemorrhagic fevers like Ebola to HIV/AIDS if you need an emergency blood transfusion.

It's a jungle out there.

You can't just blame unfamiliar bugs or other countries' lack of sanitation when you get sick on vacation. Some of the responsibility - and therefore the ability to stay healthy - rests squarely on the traveler's shoulders.

Collin Somersall of Ellicott City no longer lets his wife plan their vacation cruises. After a terrible bout of seasickness on his first cruise, he now picks their cabin location very carefully.

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"I've checked the ship; I've done the research," the 57-year-old financial adviser says of their planned Alaska trip this summer. "If there's a failure, it's my fault. And I'll be sure I have my Dramamine."

Somersall is the exception, insist the professionals.

"One of the biggest problems is that a lot of people tend to develop a holiday frame of mind," explains Dr. Thoburn Dadisman, medical director of preventive medicine at CareFirst in Baltimore. "They think nothing can happen."

His advice is simple: Plan ahead.

Start with getting information on the Internet, perhaps from the Center for Disease Control's Web site. (See the accompanying box for more sites.)

Dadisman also suggests talking to your physician at least eight or nine weeks in advance to see if you need vaccinations, which may take up to two months to become effective. "Folks tend to put them on the back burner until a week before the trip. Then it's too late."

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Depending on the cost of the trip, its length, and how exotic the location is, he recommends travelers insurance. In an emergency, it will pay for an air ambulance for medical evacuation. The possibility is remote that you'll need it, but you're buying peace of mind for a few dollars a day.

"It's a big deal getting sick in a foreign country," he says. "People want to come home."

Most travel illnesses, of course, aren't serious, even though they can be scary. Clara Martone-Boyce of Annapolis took an adventure trip to Venezuela a couple of years ago that included a canoe ride into the jungle. In the canoe she started to feel sick to her stomach and developed a fever with chills. As soon as they got to the campsite she lay down in her hammock and covered herself with blankets but still couldn't get warm.

"I took some Aleve or Tylenol or some other pain reliever or fever reducer and finally started to feel a little better," the 26-year-old attorney says. "I was petrified I had malaria, much to the amusement of everyone else in the group."

The next day she had recovered enough to go with the others up to Angel Falls, the world's highest waterfall.

"It was slow going for me, because I wasn't back to full strength yet," she says. "[But] even though I wasn't able to hike as high as I wanted that day, once we came down I felt better. So I doubt it was malaria."

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A new field

In the last 20 years a new health field, travel medicine, has arisen to prepare people for trips overseas with information and inoculations. Travel medicine specialists are even more helpful when you come home with diseases not usually seen in your internist's office - like malaria.

There are many reasons for travel medicine's growth, says Dr. Stuart Rose, whose Web site, www.travmed.com, is a source of information and products for travelers. He cites the explosion of globalization, the increased interest in adventure travel and camping, and - if you want to be cynical about it - the desire of medical providers to find another line of profit (giving inoculations for exotic diseases).

In spite of people's fears that they'll catch a potentially fatal disease, says Rose, "The biggest risk of dying overseas isn't malaria, but a car accident."

The No. 1 malady people have to deal with on a trip, he explains, is traveler's diarrhea. Travel medicine specialist Elaine Jong believes that over half the people going to tropical destinations get it.

You've heard the advice: Boil it, cook it, peel it or forget it.

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"That's pretty good advice, but it doesn't provide 100 percent protection," says Jong. "When there's a high degree of environmental contamination, the bacteria can be breathed in."

And for those of you feeling really paranoid, some experts now recommend avoiding bottled water unless it's carbonated. (It might have been contaminated before it was bottled.) And remember "hidden water": You get it in ice cubes and while brushing your teeth or taking a shower.

Raw fruits and vegetables can be problematic: That's not news. But some travel professionals now suggest eating only thick-skinned fruit like bananas or oranges. Even peeling thinner-skinned fruit before you eat it may not protect you. The degree of danger, of course, depends somewhat on where you are.

Are we going overboard here?

"Travel is exceptionally safe," says Deborah DeYoung, spokeswoman for AAA Mid-Atlantic. "Mostly it's a matter of slight discomfort you can avoid if you just remember you aren't home. The vacation attitude is to throw caution to the wind."

She has five tips:

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Eat very hot food. Heat kills most bacteria on food.

Stay away from salads.

Cold foods should be very cold. (Watch out for those buffets in hotels and on cruise ships.)

Wash your hands often. "Good general hygiene serves you well."

Don't overdo it. When you're jet-lagged, tired or stressed by travel, you're more susceptible to bugs. Especially when traveling with small children, she recommends the "two-event rule." Don't pack too much into a day.

Family affair

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Traveling with children, of course, is a whole other story. Baltimore pediatrician Dr. William Waldman gets calls about his patients from all over the world when they and their families go on vacation. He has no problem with it.

"It's better to do that," he says, "than just show up at some local doctor's office."

Prescriptions can be phoned in, he points out. He also recommends that parents pack only two medicines when they vacation (other than specific prescriptions, of course): pain medicine like Motrin and an antihistamine.

Waldman takes a commonsense approach to travel overseas and health concerns.

"The same things happen in Madagascar that happen in Ocean City," he says. "People get too much sun, or they don't drink enough fluids, or they party too much."

There is one precaution Waldman suggests for those planning a trip out of the country. He recommends joining the International Association for Medical Assistance to Travellers at www.iamat.org. Membership is free, and you will have access to competent medical care by Western-trained doctors who speak English. The doctors' fees are set at a reasonable amount.

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At this point you may be thinking you should just stay home next vacation. Be warned: Doing so may not protect you from getting sick.

Dutch investigators published a study in the journal Psychotherapy and Psychosomatics last year about their newly discovered syndrome, "leisure sickness." Those who suffer from it get tend to get colds and vague symptoms like nausea and muscular pains on weekends and vacations.

The only cure is to go back to work.

Helpful Web sites

The Web is a useful tool for those looking for travel medicine information. Here are a few of the many sites available:

International Association for Medical Assistance to Travellers.

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www.iamat.org

Membership is free, and you get a directory of reputable, English-speaking doctors, hospitals and clinics in 125 countries with a set fee schedule.

National Center for Infectious Diseases Travelers' Health

www.cdc.gov/travel/index.htm

Information on health concerns and vaccinations for specific destinations. Covers everything from African sleeping sickness to yellow fever.

International Society of Travel Medicine

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www.istm.org

A start for people who want health information and vaccinations before their trip. You can call up a list of all the travel clinics in this area, for instance.

Travel Medicine Inc.

www.travmed.com

The site has a world medical guide and products like an individual water filtration bottle, plus a what-to-take checklist scary enough to keep you at home.

Travel Health Online

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www.tripprep.com

Detailed health advice about more than 220 countries, including crime warnings.

More general medical information sites like www.healthcentral.com and www.webmd.com also have good, commonsense healthy traveling tips.

Health tips for the traveler

Here's how to have a healthy vacation -- or deal with illness if you don't.

* Don't wait for the last minute to get health information.

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* Consult your doctor about over-the-counter drugs to take.

* Fill your prescriptions in advance.

* Wash your hands even more than usual.

* Be careful about what you eat and drink, but don't go crazy.

* Some experts suggest drinking only bottled water that's carbonated.

* Especially if you're traveling with kids, don't try to do too much.

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* Get enough sleep, even if you are on vacation.


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