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Plan your trip, see your doc, get your shots, pack your bags

November 06, 2005|Kathleen Doheny | Healthy Traveler

YOU'RE in great shape. You watch your diet and exercise, and you don't smoke or drink. Your itinerary is a little strenuous, but that's no big deal. Or is it?

It can be, doctors say. And that's why they suggest a pre-trip checkup, whether your destination is Africa or Illinois, and especially if you're recovering from an operation — including plastic surgery — or taking a course of chemotherapy, among other things.

A checkup also can reveal things you only suspected. Take, for example, the case of two doting grandparents who had decided to treat their family, all 15 of them, to Christmas in Kenya. They were patients of Dr. DeVon Hale, director of the University of Utah's International Travel Clinic.

Several weeks before their trip, they stopped in at his Salt Lake City clinic to figure out which immunizations they needed.

Just before Hale gave them yellow-fever shots, he asked whether anyone might be pregnant. The 42-year-old grandmother said she'd had one indication that she could be pregnant, and a test soon confirmed her impending motherhood.

"The yellow fever [vaccine] at that point in pregnancy could have been dangerous," Hale says.

The family canceled the trip and rebooked it for the next year — all 16 of them, Hale says.

A pre-trip medical checkup isn't always as eventful, but the case illustrates the importance of getting a physical before you head off.

Whether you decide to see your own doctor, a travel medicine specialist or both depends on your age, health and destination, experts say.

Dr. Victor Kovner of Bonsall, Calif., a travel medicine specialist, offers this guideline: "See your own doctor for clearance," he says. "See a travel doctor for specific immunizations."

People of any age with serious chronic conditions — among them heart problems, diabetes and asthma — need to get clearance before a trip. See your doctor if you have just finished chemotherapy; have a pacemaker; are taking medications, such as blood thinners, where the dose is crucial for effectiveness; or have had recent surgery.

"If the patient has had plastic surgery within the last 30 days, it's a good idea to check back with your plastic surgeon before flying," says Dr. Brent Moelleken, a Beverly Hills plastic and reconstructive surgeon. "The plastic surgeon may give you tips like 'Don't swim' or 'Don't get too much sun.' "

As a rule, Moelleken says, if your surgery requires cutting, the 30-day rule applies. Not on his list are minor procedures such as injections of Botox or fillers to minimize wrinkles.

And any traveler with a compromised immune system needs a pre-trip evaluation.

What if you are healthy? Do you need a checkup?

That's where age is a factor. People 55 and older should be evaluated by their regular doctor for heart disease, high blood pressure and stroke risk, especially if they are planning a strenuous trip or adventure vacation. "There's nothing worse than having a dream [vacation] and not being in shape physically," Kovner says.

Hale's litmus test: "If you are older and going to do things you don't do at home, get checked. "

If you are going someplace with a substantial risk of communicable disease, you should visit a travel clinic, Hale says.

Physicians who have an interest in travel medicine stay current on vaccines and medications for specific locales. If you're headed to countries where malaria or yellow fever are prevalent or to countries, such as Mexico or those in Africa, Asia and Central America, where there's a high risk of illness from contaminated food and drink, you may benefit from a travel medicine consultation, Hale says.

But for trips to Western Europe, New Zealand and Australia, a pre-trip visit to a travel medicine specialist, although valuable, is probably less crucial.

To help the specialist evaluate your treatment, take your itinerary, inoculation record and a list of medications. And schedule your appointment at least a month or two before your trip, enough time to fit in most needed vaccines, Kovner says.

Besides immunizations and anti-malarials, a travel medicine doctor and clinic should also give you information on insecticide use and how to combat jet lag and avoid disease, Hale says.

Such specialists may have to consult your regular physician because certain medications may be affected by immunizations or travel medicines. Some cardiac drugs interact with some anti-malarial drugs, Hale says, and some medicines for rheumatoid arthritis interact with some live vaccines, such as yellow fever or measles.

But such contraindications don't mean you'll have to give up the trip. Sometimes you can stop the medications long enough to be given the vaccine.

"A comprehensive pre-travel evaluation for a chronically ill or older traveler should be a combined effort between their regular doctor and the travel medicine doctor," he says.

Kovner tells the story of a 75-year-old man with congestive heart failure who had always dreamed of going to China. His cardiologist advised against it.

"[The patient] came to me, really disappointed," Kovner says. "I asked him, 'What if you die there?' " The man said it would be worth it.

Kovner thought the patient could do it if he were careful.

"I told him to take it easy, walk slowly, have evacuation insurance, go for a wheelchair if needed, and modify his activities to his tolerance for exercise."

He went and had a great time. When he died two years later, it was with the knowledge that he'd fulfilled his travel dream.


Healthy Traveler appears every other week. Kathleen Doheny can be reached at

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