Backpaking Health Problem (euuuhh !)

Posted by Fico , Tuesday, September 23, 2008 7:11 PM

I read an article from a website and i think its good for all to know. Especially those who had weak tummy !

These are some highlight from the web (New York Times):
* Not all cooked food is safe food. It may have been cooked some time before and held, then warmed. The food should be really hot when it is put before you, to be sure the bacteria have been killed. If you are eating in a restaurant, send a hamburger back if it is not steaming hot.

* Hot sauces that are left on the table from meal to meal should be skipped. The research found them to be heavily contaminated.

* Traditional advice about fruits is usually to eat only those that can be peeled. Watermelons, out of the rind or in, were found to be not safe, however, because many had been injected with water to make them heavier at the moment of sale.

* Milk is generally always a bad bet. It is often ''pasteurized by law but not by boiling'' .

* Many attacks of diarrhea on the return home can be traced to food served on the airline that was prepared and placed aboard in Mexico and is as likely to be suspect as anything sold in a restaurant. ''It's served by a U.S. flight attendant, and it's a U.S. airline,'' Dr. DuPont said, ''and everybody eats what's brought to them. Much diarrhea derives from lowering the guard.''

Heres some other desease that we could catch during backpacking traveling (from backpacking the planet website) :

Tummy aches and food mistakes

Many, many travelers have made inadvertent, or sometimes careless, food mistakes, and paid for them with tummy aches and associated not-so-nice symptoms. More often than not a traveler to a lesser developed country will have some degree of gastro-intestinal distress at some point. See Food to learn how to best avoid these problems.

When you find yourself in the throes of nausea, vomiting and diarrhoea you need to first remember that recovery is all but assured. You are not going to die. Most bouts are self-limiting (two to ten days), and the cause and severity will determine how you choose to treat it. First, assess your case. A sudden onset of relatively uncomfortable diarrhoea; meaning you can pinpoint the time it started and it's been bad from the start, generally indicates a bacterial cause. Other symptoms can include fever, vomiting or blood in the stool. If this describes your bout, consider taking your dysentery antibiotic (Ciprofloxacin or Norfloxacin) that your travel doctor prescribed in your pre-trip consultation. Relief sometimes comes after only one dose, but make sure that you are not vomiting so that the medication stays down. If symptoms persist, you may be experiencing a viral infection, while if symptoms subside unmedicated after only a day, you may be experiencing food poisoning by toxins. If onset of symptoms is more gradual, coming on over the course of a few days, you may have a protozoal case, such as Giardia ('beaver fever'). Depending on the diagnosis, treatments are available.

No matter what the cause, you will want to treat the symptoms somehow. Try a hot water bottle on your stomach to relieve pain and muscle spasms. Drink plenty of fluids to avoid dehydration, including hot tea, purified water and soft drinks. Avoid too much sugar or sodium. If vomiting or diarrhoea are severe, consider pre-packaged rehydration salt solutions available at drugstores and pharmacies. You can also mix up your own solution using a teaspoon of honey or corn syrup and a pinch of salt in an 8 ounce glass of apple or orange juice in one glass and a teaspoon of baking soda in a 8 ounce glass of purified water and drinking alternatively. If your schedule dictates that you need to stop diarrhoea more or less immediately, Imodium or Loperamide, will be your friend. Take this only if necessary though as a week of constipation will likely follow.

When ready, reintroduce foods beginning with dry toast, crackers and clear soups. Avoid dairy products, alcohol, high fibre foods, fatty foods and caffeine. Stick with bananas, potatoes, noodles and apple sauce until you are one hundred percent again. And eat yoghurt - it contains lactobacillus, a bacterial culture that can inhibit the bacteria that make you sick. Try pre-packaged yoghurt as both a prevention and a treatment.

Malaria and other serious illnesses

When any medical symptoms arise in a foreign country, the first thing you will want to do is rule out anything serious. You will need to stay in this mindset even after you return from travelling as some tropical diseases can take weeks, months or even years to surface. If you develop symptoms after returning from tropical travel, consult your travel health specialist or visit a tropical disease unit in a hospital in your area and divulge your recent travel itinerary.

Many illnesses and diseases are indicated by fever and flu-like symptoms. They can often be distinguished by the characteristics of the fever as well as other accompanying symptoms. To be absolutely certain, blood tests should be carried out in safe, reliable, hygienic facilities. Viral syndromes (such as Influenza - the flu), are characterized by a sudden onset fever with a motion-sensitive headache which lasts two to four days untreated.

Malaria, contracted through infected mosquitoes, has an incubation time of at least one week, meaning your symptoms will not surface for a minimum of seven days. There are four main strains of Malaria, each with varying symptom characteristics and treatments; one of the more common of the four is rapidly fatal. Malaria presents with an abrupt onset of chills followed by sweating and a high fever lasting for several hours before a marked improvement. Symptoms return in a second bout, or sometimes, a steady fever may be present. Patients should seek a blood test if available, then treat accordingly. Treatment generally involves a course of Fansidar, and depending on the strain, may require other follow-ups. If you have a blood test, keep a copy of the results and consult your travel specialist when you return home. To read more about preventing the contraction of Malaria, see Insects below and also Prepare for Your Best Health.

Dengue fever is another infection carried by mosquitoes, though this time the offending mosquito is the type you are more likely to find in the day time or in more urban areas. There is a three to ten day incubation time for this disease, which presents with a sudden onset high fever, almost always with a headache behind the eyes, exacerbated by motion of the eyes. Muscle and back aches are prominent and any of nausea, vomiting or a rash on the skin of the trunk may be present. After three to six days, the symptoms will suddenly lapse though the victim may suffer fatigue for weeks. There is unfortunately no vaccine nor any treatment for Dengue fever, and it is therefore best dealt with through prevention of mosquito bites.

Typhoid (or Enteric) fever is a bacterial infection of the intestine contracted via contaminated stool. Although vaccination is available and suggested, it is not 100% effective and should not be used to rule out diagnosis. Typhoid is indicated by a gradual onset of low fever, a dull, non-motion-sensitive headache, a slow pulse and fatigue over several days. After this time, the fever rises markedly as does the level of fatigue. Pink spots on the body may also appear along with loss of appetite, nausea, vomiting and dizziness. The illness will last up to a month if untreated, response to treatment with Ciprofloxacin will be slow.

Hepatitis A is yet another illness presenting with a fever - this one a gradual onset fever accompanied by dull, motion sensitive headaches and pronounced nausea and loss of appetite. These symptoms occur after a four week incubation period and last four to five days before dark urine presents as does jaundice - a yellowing of the skin and whites of the eyes. The fever will break but nausea, loss of appetite, stomach pains and fatigue will persist for two to four weeks. This viral infection of the liver occurs via contaminated stool in food or water but will almost definitely not present if vaccination has been carried out prior to exposure. Patients should be encouraged to eat and drink as much as possible to avoid weight loss and dehydration.

Meningitis is a potentially rapidly fatal infection of the brain and spinal cord. Symptoms are a high fever and severe headaches, light sensitivity, a stiff neck and perhaps purple patches on the skin. A person presenting with the symptoms of this communicable (person-to-person) disease should be hospitalized for treatment immediately as death can occur within 24 hours.

Japenese B Encephalitis is a viral brain infection indicated by fever, headaches, confusion and altered concentration. Like meningitis, the victim requires immediate hospitalization. There is a high rate of mortality with Japanese B Encephalitis and even survivors may have altered intellectual abilities. The best defense is one against mosquitoes which carry and transmit the disease.

Yellow fever is yet another mosquito contracted illness, this one viral. Mild cases present with flu-like symptoms whereas more severe cases include nausea, vomiting, bleeding, abdominal pain and jaundice. Professional treatment should be sought if you present with Yellow fever. Many countries are attempting to eradicate this disease with required immunization certificates. You will likely have to have the vaccine if you are travelling to areas where the strain is endemic.

Cholera is an illness characterized by the severest of watery diarrhoea. Fluid replacement is absolutely vital alongside an antibiotic treatment course. Untreated victims are most likely to die of dehydration. A relatively ineffective vaccination exists for Cholera but most travellers are not at high risk for contracting this disease which transmits through contaminated food or water.

Schistosomiasis / Bilharzia is an infestation of the intestine of minute worms which enter through the skin from infected fresh water. General malaise is the first symptom, followed weeks later with a high fever. After the disease is established (months to years later), abdominal pain and blood in the urine present. If you have been swimming in fresh water in tropical areas, ensure you are tested for Schistosomiasis by a travel health specialist upon return.

Tetanus, an infection from a germ present in soil or faeces, occurs through contamination of even a minor flesh wound. Vaccination is routine and should be boosted every ten years. The disease presents with muscle contractions and breathing difficulty, discomfort when swallowing, stiffening of the jaw and neck, and finally, painful convulsions of the jaw and body. Seek medical help immediately.

Whatever else ails you

Simply due to a change in pace and contact with many and varied public areas, your traveling lifestyle will leave you more vulnerable to germs causing common colds and other minor infections. Feeling under the weather away from home is not fun, and being stuffed up in hot and muggy climates is most uncomfortable. Speed up your recovery by getting lots of sleep and drinking plenty of clear fluids. Pharmacological cold and flu remedies aside, there are some things you can do to ease the discomfort of symptoms. If you are stuffed up, try clearing your sinuses with hot spicy foods, mustard, garlic, ginger or onions. These foods also have healing properties. Or try a dab of Tiger Balm under your nose. Creating a mini sauna by filling a sink with steaming hot water and leaning over it with a towel draped over your head may bring relief too. Soothe a sore throat with hot tea, and try gargling with an anti-bacterial mouthwash or warm salty water. Avoid dairy products.

My first line of defense against headaches is drinking a liter of water, as such maladies are often brought on by dehydration. Treat sore muscles with Tiger Balm or a hot water bottle. You can fashion the latter using a plastic twist top pop bottle filled with hot water and wrapped in a towel or placed in a sock. You can also use a hot water bottle to ease stomach cramps.

Treat minor cuts and scrapes more seriously than you would at home. Wash immediately with soap and water, apply an anti-bacterial ointment and cover with a bandage or gauze. Let the wound dry when you are sleeping at night or are at rest. Allowing an open wound to become infected is never a good idea but even worse when you are travelling and susceptible to more strange and varied bacteria. The beginnings of an infection can be identified by swelling, heat, redness and tenderness of the area. You can fight a minor infection with anti-bacterial ointment but if improvement is not seen in a day or two, seek medical help. Once an infection becomes serious enough to get help, you will likely be told to avoid getting the wound wet, which precludes swimming and showering. That's no fun.

Doctor visits and medication overseas

As it is always better to be safe than sorry, there is a chance that you will end up in a doctor's office with anything from malaria to an infected cut, a broken arm to an itchy rash. Seek out an English speaking doctor, preferably one recognized by the IAMAT association (www.iamat.org, see Prepare for Your Best Health). The IAMAT recognized practitioner should be able to provide competent care at a fair and reasonable price. If this is not possible, don't be afraid to contact your embassy for a recommendation.

Don't be afraid to ask plenty of questions of your doctor, or to persevere to the point of understanding. Offer up as much information related to your condition as possible and voice any concerns you have. This is especially the case if you decide to accept any treatment. If you need an injection (for treatment or vaccination), make sure you see the syringe come from a sealed, sterile package. Offer your own if you have chosen to carry them with you in your first aid kit. The same goes for needles used in acupuncture. You will also want to avoid a blood transfusion unless one is absolutely imperative to save you life.

If the doctor prescribes a medication, ask about the side effects, the dosage and any contraindications or interactions with other drugs you may be taking, as information printed on or in its packaging may not be in a language you can read. This includes herbal medications, which are not necessarily risk-free by virtue of their natural source. When you purchase your prescribed medication, it is best to do so from a pharmacy attached to a hospital, or one recommended by the staff at your embassy. Check the packaging carefully to make sure it is sealed and still in date; watch also for cheaper versions of expensive drugs - use your judgement on this one. As with any medication, make sure you take the full course as prescribed even if your symptoms have cleared.

Make sure you get an itemized and detailed bill for all of your medical attentions. It will help if you acquire claim forms ahead of time, or if you are familiar with the information that your insurance company requires for a claim (such as doctor's name, time of visit, diagnosis, etc.). Some insurance companies impose a limit on the amount of time elapsing between the time of the medical attention and the time you file the claim. Find out what this time is, and if you are going to be away for longer than that time, carry claim forms with you so that you can file a claim from the open road.

Medical emergencies

Emergencies are defined in part by their urgent nature. It is therefore best to be prepared to react before emergencies occur. Know where to access phone numbers for local emergency services (police, ambulance, fire department). This may involve book marking a page (or pages) in your guidebook. Also consider employing help from your home countries embassy and your health insurance companies' hotlines. Depending on the nature of the emergency, you may wish to contact the victims health insurance company before treatment is sought in order to get a recommendation on what courses of action to follow that will be reimbursed. Embassies will also be useful in recommending the best local care if you have time to contact them before treatment is sought or carried out. Most embassies will have 24-hour emergency hotlines. Your government back home will also likely have a 24-hour emergency hotline that you can call collect to.

For Canadians, the Consular Affairs of the Department of Foreign Affairs and International Trade maintains a 24-hour emergency service. Services are available for Canadians overseas who may encounter such problems as illness, accidents or death, evacuation, financial difficulties, child abduction or custody issues, kidnapping, missing persons, arrest/detention, and lost or stolen passports. Assistance is also available for family and friends in Canada seeking help and support for persons overseas. These services are managed from Ottawa. Consular officers in the Department's Emergency Operations Centre work closely with officials located around the world. If an emergency occurs while travelling abroad, call the nearest Canadian mission or make a collect call to Ottawa at (613) 996-8885. Check out www.voyage.gc.ca for more information - follow the Problems Abroad? link.

You will want to have all of these phone numbers handy. You may want to copy them all onto one piece of paper that you can access at any time. Photocopy these numbers and keep them in more than one place in your backpack and daypack. Also prepare ahead of time by having emergency contact names and numbers back home for yourself and each of your travel mates.

If you are present at or come across an emergency situation, the first thing you need to do is consider your own safety. Make sure the area is secure before you attend to a victim (check for fire and electrical hazards, the presence of poisonous substances, dangerous animals or people, and unstable structures or environmental hazards). Call for help immediately and continually reassure the person verbally, whether they are conscious or not. Begin your first aid by checking for breathing and pulse, then let your instincts and training kick in. I highly encourage all travellers to take first aid training before departure. Some basic knowledge could save your own or other people's lives.

Insects

Depending on where you are travelling, you may very well by sharing your travelling experience with myriad strange and wonderful insects.

By far the biggest concern on the insect front is the common mosquito. Mosquito bites are an itchy nuisance for most people, but more importantly, they can transmit malaria, Japanese encephelitis, yellow fever and Dengue fever. Immunizations and malaria prophylactics aside, it is best to prevent mosquito bites altogether. Mosquitoes can strike both day and night, so protect yourself always. During the day, choose lighter colours over bright or dark colours and wear long sleeves and pants if the situation warrants. Avoid scented shampoos, deodorants, soaps and suntan lotions. In the evening, consider burning mosquito coils or citronella candles. At night, sleep with a mosquito net, a contraption designed to be suspended over you and to completely surround you in your bed. If you are visiting high risk areas, it is best to be prepared with your own net though in many locales where malaria or mosquitoes could be a problem, places of accommodation will provide nets. Check your net for holes and mend with needle and thread or tape on both sides if you find any. Alternatively you could twist the net to conceal the hole and fasten with safety pins or paper clips. Make sure your net is completely covering your bed and you may want to try tucking it under your mattress. Try not to lie against the net in your sleep as mosquitoes will bite through.

The other prevention option is mosquito repellent. DEET (N, N diethyl-meta-toluamide) has proven to be highly effective and is available to the consumer in lotions, sprays and liquids in concentrations from 8 to 98 percent. Although DEET is an approved substance for use by humans and is deemed safe for regular use, DEET is a toxic chemical. The fact that it should not come in contact with synthetic fibres (such as your quick-dry pants or your Gore-tex raincoat) or plastics (eyeglasses, pens, water bottles) calls to attention that it should be used with some degree of caution. Do not use it on broken skin or near your eyes. In lower risk situations, consider trying more natural alternatives such as citronella sprays. Other suggestions from the peanut gallery include rubbing alcohol, cedar oil sprays and menthol balms like Tiger Balm or Vick's Vaporub.

For more information on pharmacological precautions (immunizations and malaria pills), see Prepare for Your Best Health. For information on diagnosing and treating malaria, Japanese encephalitis, yellow fever and Dengue fever, see Malaria and Other Serious Illnesses above.

There are many other insects that you may come across. There are a few poisonous breeds out there (such as black widow spiders and scorpions) so you should familiarize yourself with any inherent to the area you are visiting. Check your guidebook and seek out local knowledge upon your arrival. Backpackers are prime targets for encounters with cockroaches, from pin-head to almond sized. These creatures are harmless but can be a nuisance. Keep your bags zippered shut and your flip flops on. You may also want to check your shoes or boots before putting them on in the morning in case someone (poisonous or not) has decided to make them their home overnight. Wasps and bees can be found in many locales as well. Avoid them as you would at home, but keep in mind that their stings are generally only painful rather than dangerous unless you are allergic. If you have been diagnosed with an allergy to bee or wasp stings, be sure to carry any required medications with you.

Bothersome insects of a smaller scale include bedbugs, lice and various mites, ticks and fleas. All result in itching, if nothing more. Bedbugs are called such because they often choose to reside in mattresses and dirty bedding and because they most often choose to come out at night. They are somewhat similar to mosquitoes in that while harvesting your blood during a bite, they inject a substance into your skin which creates that dreaded itch. Bedbugs, however, are perhaps slightly more industrious as they will bite several times in neat rows. Some people react worse than others, but if you have the misfortune of an encounter with these creatures you will most likely want to find a different bed to sleep in, and you will want to wash any clothes and such that may have become homes for the bugs. Lice (head lice, body lice or crabs) are contracted through direct contact with infected people or shared use of combs, clothing, etc. Treat with special shampoos and wash your clothing and bedding in hot soapy water. Fleas are best warded off by avoiding contact with animals, especially rural residents or strays. When exploring the natural world, be aware of sand mites and the like, and especially of ticks. Ticks cling on to you something fierce and can cause skin, or more serious infections. Remove ticks by squeezing the skin around them and removing them by their head that is attached to your skin rather than by their body.

Treat various itchy and stinging bites first with soap and water, then with Calamine lotions and /or anti-sting sprays as you see fit. Antihistamines or anti-inflammatories can help in some cases as can ice to reduce swelling. Itching may be relieved by a bit of toothpaste, a baking soda paste or Tiger Balm.

Heat and sun

Our travels often take us to climates hotter than we are accustomed to, and adaptation can take weeks. Heat is a serious consideration with consequences more than turning Sunlight-fresh laundry into sweaty sludge. In sweaty circumstances, protect your documents in money belts and pouches from sweat by wrapping them in a plastic bag. Protect your skin too, from "prickly heat" rashes (due to excessive perspiration) with a mild talcum or a prickly heat powder. Ease your vulnerability to heat by wearing appropriate clothing (lightweight and lightly coloured hat, shirt, pants, shorts or skirt keeping cultural considerations in mind), by reducing physical exertion and by maintaining a sensible diet and a high intake of fluids. Drink more than is necessary to quench your thirst - dehydration is evident with dark or a lack of urine. Applying a damp cloth around your neck can also cool you off. In extreme heat, take a cold shower or find a place to swim - some hotels will sell day passes to non-guests.

Two heat related conditions to watch for are heat exhaustion and heatstroke, the former of which can lead to the latter if allowed to progress untreated. Heat exhaustion, the less serious of the two, occurs due to dehydration and salt deficiency. Characterized by fatigue, lethargy, headaches and muscles cramps, victims should be treated by removal from high temperatures and by increasing fluid and electrolyte intake. In severe cases, victims should rehydrate with pre-packaged rehydration salt solutions available at drugstores and pharmacies, or self-prepared solutions as discussed in Tummy Aches and Food Mistakes above. Heatstroke is the second, more dire consequence of exposure to heat where the bodies heat regulating mechanisms fail and the core body temperature rises to dangerous levels (above 39�C or 102�F). Victims sometimes stop sweating altogether and will experience throbbing headaches and general malaise and eventually confusion, aggression and convulsions. Hospitalization is essential in cases of heat stroke, with removal from heat and of clothing and application of cold, wet sheets, a fan and cool drinks in the interim.

The strong rays of the sun, especially in these days where the earth's natural ozone defenses have been broken down, are another environmental force to be reckoned with. They must be reckoned with especially by the traveller who is likely to be spending a lot of time outside in the sun. You will want to avoid excessive exposure to the sun in order to prevent painful sunburn in the short term and permanent skin damage in the long term. Be aware that you can burn through cloud and fog, and even more so while at high altitude or due to reflection from sand, snow and water. Certain medications also increase the skin's photosensitivity, sometimes markedly. Such medications include antibiotics, antifungals, antihistamines, some antimalarials, oral contraceptives, tranquilizers and some drugs used to treat diabetes.

The first line of defence against harmful UV (ultraviolet) rays is staying out of the sun in peak hours (11 a.m. to 3 p.m.), but as this isn't likely to always happen, the traveller should be sure to cover as much skin as is comfortable with a decent thickness of clothing. Wearing a hat with a brim and UV-rated sunglasses to protect the eyes are essential measures as well. Protect your back while snorkelling by wearing a t-shirt. Exposed skin should be covered generously and often with a sunscreen rated with a high SPF (sun protection factor), preferably beginning half an hour before exposure. Commercially available SPF's range from 2 to 60 or more - you are best to choose one 15 or higher and to avoid so called 'tanning' or 'bronzing' oils. Reapply the sunscreen after swimming or sweating, even if your screen claims to be waterproof and sweatproof. Don't forget your ears, your feet and any exposed areas of your scalp! Special sunscreen sticks are available for your lips, sprays for your scalp and high protection zinc-based sunblocks are available for vulnerable noses and cheeks, and anywhere else you wish to cover.

If the sun gets the better of you, you will have to be extra diligent in staying under cover for a few days. Drink plenty of fluids and use a lotion on the burn, preferably with healing properties such as a component of aloe vera. Folk remedies include a half hour of coating your burn with a paste of cool, plain yoghurt rinsed off with water. Treat burned eyes by covering your eyelids with cucumber slices or tea bags soaked in cool water. In the severest circumstances, you can try an anti-inflammatory, such as ibuprofen. To reduce friction from bed sheets, try spreading powder on the sheets.

Altitude

As the level of land above sea increases, the air we breathe contains less and less oxygen. People have climbed to the highest point in the world (Mt. Everest at 8848m or 29,028 feet) without supplemental oxygen but they have had to be supremely acclimatized to do so. Acclimatization begins to be an issue at an altitude of 2500m (8000 feet). If you ascend at the right pace, your body will acclimatize and be able to cope with the lower levels of oxygen in the air. The rate at which your body adapts is unique to you - some people's bodies deal with altitude better than others and this ability is generally not associated with a level of mental or physical fitness. If you practice proper acclimatization techniques each and every time you go to altitude, you increase your chance for safety and comfort; it you ignore them you are at a very real risk of death. After descending from altitude your acclimated state will not last beyond a couple of days.

Ascending slowly to altitudes above 2500m helps your body acclimatize over time - this is the best way to do it. As you work your way upwards, it is primarily the altitude at which you sleep that should be used to mark your progress. Safe ascents generally do not exceed 300 to 400m per day and include a rest day at every 1000m benchmark. This means that the level at which you sleep one night should not be more than 400m above the level that you slept the night before. Every time you reach a multiple of 1000m above the level you started at (or above 2500m), you should stay at that level for two nights. It is generally okay to ascend to higher levels during the day, as long as you descend again in order to obey the rules for sleeping. On rest days, it is encouraged that you hike to a higher altitude, say for lunch, just to promote your bodies acclimatization efforts.

If you arrive suddenly at altitudes over 2500m, or if you ascend too quickly, you are at risk for acute mountain sickness (AMS), also known simply as altitude sickness. Symptoms are headaches, sleeplessness, nausea, vomiting, loss of appetite, tightness in the chest and confusion. You need to be able to recognize these symptoms and be willing to accept that they are due to altitude. As long as you have any symptoms of AMS, you must not ascend to sleep at a higher altitude. If symptoms are mild, you will need to allow your body time to acclimatize at whatever level you are at. You must not ascend until your symptoms go away. To ease the discomfort of these symptoms, you may wish to take acetazolamide (DIAMOX). This drug is prescribed to actually help the body deal with the lower levels of oxygen by increasing your respiratory rate, rather than simply masking symptoms, but it will not prevent the progression of severe symptoms. Side effects of this drug include tingling of the hands and feet and sometimes fatigue, sleeplessness or nausea, which begs the question of why bother? It is a personal choice of whether or not you take the drug.

If symptoms become worse while you remain at a given altitude, or are generally more severe, you will need to descend. Descending as little as 500m will begin to help; ideally you will want to descend to the level where your symptoms improve and eventually disappear. In dire circumstances, emergency medical treatment can include the administering of bottled oxygen or enclosure in an individually-sized pressurized Gamow bag.

There are two conditions more serious than simple AMS, both of which can either can show a rapid onset but more often result from ignoring the proper acclimatization techniques and AMS symptoms. Known as High-Altitude Pulmonary Edema (HAPE) and High-Altitude Cerebral Edema (HACE), these conditions require immediate descent. HAPE is an accumulation of fluid in the lungs. While everyone will experience breathlessness upon exertion during the acclimatization process, you will need to pay attention to how you recover at rest. Breathlessness during rest, or the inability to catch your breath within ten minutes of resting, is the sign of the onset of HAPE. If you experience this type of breathlessness, you must descend. Although exertion exacerbates symptoms of HAPE, the descent to a lower altitude is imperative as the first line of treatment. If HAPE is allowed to progress untreated, symptoms will include coughing and the production of a pink, frothy sputum. The victim will eventually drown in the fluid in their own lungs. The second condition, HACE, is the accumulation of fluid in the brain. Headaches, fatigue, nausea, loss of appetite and vomiting are common symptoms of basic AMS, but in severe form, can lead to extreme fatigue and ataxia; a loss of balance and co-ordination. These are the symptoms of HACE and when they present, the victim must descend. Test for ataxia by administering the 'drunk test' where the patient walks a straight line placing the heel of one foot at the toe of the other as they walk forward. If the patient can not complete this task, they are showing the symptoms of HACE and they must descend as unconsciousness is imminent and will be followed by death. The symptoms of both HAPE and HACE can be treated with drugs in emergency circumstances (nifedipine and dexamethasone respectively), but descent will still be necessary and paramount.

Having presented all the dangers, altitude is not something you need to be scared of. You simply need to be aware of the symptoms of AMS, and to follow the advice of not ascending with any symptoms and descending if you have symptoms that are worsening while you rest at the same altitude. Symptoms do not occur with such a sudden onset that you will not have time to take the necessary precautions.

Oh, and remember that it is easier to sunburn at higher altitudes, so wear your hat and sunscreen!

Feet

These relatively small parts of our bodies are usually all but ignored when they are happy, but can make a big impact on our travels when they are not. Moral of the story? Pay a little bit of attention to preventative foot maintenance and all should be well.

The airplane is not the right place to be breaking in a new pair of shoes or boots. Try to pack footwear that has been tested, tried and true to your feet prior to your travels. Your biggest risk is blistering due to friction. Try to keep your feet clean and dry, and reduce friction by applying a powder or Vaseline to your feet. I also swear by polypropylene sock liners for hiking, to wick moisture from your feet and to provide a thin layer to absorb some of the friction. In dire circumstances, you can use a very thin plastic bag. You may also wish to apply moleskin (available in small sheets or strips at pharmacies and some sports/footwear stores) to sensitive areas before problems begin. If you do succumb to blisters, you are at risk for infection, so this is definitely the time to keep your feet clean and dry. Try not to pop the blisters if possible, or if the pressure is building up, you can use a sterilized needle to allow the blister to drain. Folk remedies include soaking your feet in warm water with tea bags, slightly salty water, or applying a baking soda and water paste. If infection looks imminent (the area is warm, red and puffy) try an antibiotic ointment and sterile bandages. Obviously you will want to avoid wearing the shoes that caused you problems to begin with.

The best way to protect your feet from cold and wet environments is by choosing the right combination of shoes and socks. If you are planning to do much hiking or trekking, be prepared with the right equipment from home (See Gear Shop: What to Take). If you suffer from leaky boots in cold weather, try putting your socked feet in plastic bags - your feet will be wet from sweat but this is a better alternative then being wet from cold water. Wool blend socks are a good choice in this situation as they will still retain heat when wet. Wet shoes and boots should be air dried in a warm place, but not too close to a heat source which could warp them. Stuff them with newspaper to avoid shrinking or a change in shape.

Protect your feet from spiders and snakes by checking your footwear before putting them on each time - just in case some type of creature has found your shoes to be an inviting home. Protect from other invasive insects and worms by keeping closed-toed shoes on while on sand, grass and dirt. Protect from sharp stones and broken glass by not going barefoot. Protect from fungus and other mundane but bothersome afflictions by wearing a pair of plastic flip-flops in shared bathrooms (and showers), and those of questionable hygiene. Protect the rest of the world and the image of you and your countrymen by using a deodorizing foot powder or spray daily.

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