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Question about Sushi in Japan

2009-11-03T02:38:00Z

Dear Dr. Alla,

I’m going to Japan.Is it safe to eat sushi?

Andrew A.

Dear Andrew,

That’s a great question. There is probably no safer place to eat sushi than in Japan where chefs take as long as ten years to properly train. Are there risks? Sure. But, unless you are pregnant or have a weakened immune system, it is hard to imagine going to Japan and not giving sushi a try.

Here are a few things to keep in mind:

Completely cooked fish is safer to eat than raw fish.
Choose a restaurant or a stand busy with locals where it is more likely that sushi fish will be properly prepared and handled.
Limit how much tuna you eat. Tuna is high in mercury. Try smaller fish and shrimp which have lower mercury counts.

Here’s the bad news. If you do encounter raw fish parasites, the effects can range from mild discomfort to severe illness, depending on the type of worm you ingest. Most parasites cause nausea, cramps, and diarrhea but there are cases where surgery may be needed. Fortunately incidents of illness from sushi are few and far between particularly in Japan.

As always, I recommend checking with a Travel Clinics of America travel medicine physician before your departure to insure you receive all needed vaccinations and travel medications. Be sure to ask about Japanese encephalitis if you are headed to Japan.

Dr. Alla Kirsch

Question About International Travel

2009-09-29T15:44:00Z

Dear Dr.Alla,

I am getting ready to travel to visit friends and relative in Asia and I have so many questions that I don't know where to start. Could you giveme some travel tips?

Sincerely,

Ernie Y.

Dear Ernie,

Assuming you have never been out of the United States, I will outline some general traveltips.

PASSPORT verses VISA – The difference

A passport is the official, internationally recognized ID issued by the United States government. It is required for travel to nearly all destinations outside of the US for the purpose of entering a foreign country and for re-entering the US.A Visa, issued by the embassy of your destination country before you leave the US, is required for admission into many countries. For more information, go to http://travel.state.gov/travel/tips/brochures/brochures_1229.html

For more information on passports go to: http://travel.state.gov/passport/passport_1738.html

For more information on visas go to: http://travel.state.gov/visa/visa_1750.html.

OVERSEAS TRAVEL HEALTH and SAFETY

Visit with a Travel Clinics of America physician with your itinerary 60 - 90days ahead of your scheduled departure. A travel medicine physician has all ofthe latest information with regard to health conditions that you may encounter while traveling abroad. After reviewing your medical history, this physician will advise and administer vaccinations and booster shots. Travel Clinics of America physicians are dedicated to'safe travel' and will further advise you on safety issues specific to the region of the world you are visiting. The doctor will provide you with a list of medical supplies you should carry as well as safety tips that will help protect you and your possessions. Also you will be advised as to what medical paperwork and prescriptions you should carry.

EMERGENCY CONTACT

It is important to leave copies of your itinerary with family members and other people close to you. You may also want to register online with the US Department of State at https://travelregistration.state.gov/ibrs/ui/

MEDICAL INSURANCE COVERAGE

You'll need to check with your health insurance provider tosee if you have worldwide coverage. If you need health insurance, there are special travel policies available.

CELLPHONE

Make sure before you travel abroad that your cell phone will work when you leave the country. You may want to call your phone provider to discuss the specifics of your phone, your service and your travel destination. Double check that your charger will function. You may need to take an electrical adapter.

TRAVEL SAFETY TIPS:

Passport stolen?

Just in case your passport is lost or stolen, carry a copy of your passport, a certifiedcopy of your birth certificate and/or expired passport as well as extra passport photos.

Money

Always carry multiple forms of money: cash, travelers check, debit and credit cards. Never carry large sums of cash and use a money belt to carry your cash. Make three lists of your traveler’s checks, debit and credit cards along with emergency replacement procedures and contact numbers. Leave one at home and carry the other two but keep them in separate places.

Luggage

Mark your luggage inside and out with your name and contact information. Travel as light as possible. Don't carry everything in one place. Never pack important documents, medicine or anything you cannot do without in checked luggage. Put them in your carry-on bag.

Electricityand computers

If you take a computer (or valuable), write down the serial numbers and bring copies of receipts. Make sure insurance and warranties are up to date. Be aware that using foreign electrical current may damage your device. You may need a current converter specific to the region of the world you are visiting.

Eyewear and medications

If you wear eyeglasses or contacts, take an extra pair along with all prescriptions.

Again, this is general information. For more specific information schedule an appointment with a Travel Clinics of Americaphysician as soon as possible. Be a smart and healthy traveler so you can have a great trip!

Dr. Alla Kirsch, MD

Travel Clinics of America

Your ticket to healthy and safe international travel

Question about Rabies

2009-07-24T23:39:00Z

Dear Dr. Alla,

Why is the rabies vaccination recommended for international travel destinations, but not required here in the United States?

Sincerely,

Dennis W.

Dear Dennis,

Rabies is an acute viral infection that affects the nervous system. Worldwide about 50,000 people die from rabies each year. However rabies infections are rare in the United States due to the mandated programs available here for vaccinating pets.

For more information on the rabies vaccine, it's symptoms, treatment and prevention, read "Rabies Transmitted from Animals to Humans" at www.travelclinicsofamerica.com/diseases/rabies/

While traveling abroad, particularly in Asia, Africa, Central and South America, travelers are more likely to encounter stray animals, both domestic and wild. In these regions of the world there are no mandated rabies vaccination programs, so it is more likely for an international traveler to be exposed to rabies.

The disease is usually caused by the bite of a rabid dog. When the dog bites a human, the saliva infected with the rabies-virus is transmitted into the body of the victim.

Besides the dog, rabies may also be transmitted following a bite from other types of mammals: bat, skunk, squirrel, monkey, horse, cow, buffalo, etc.

For more information on bats and rabies, visit: The Travelogue Blog; Do I Need a Rabies Vaccine

The good news is that even if the person is exposed to rabies, the disease can be prevented with proper treatment. Without the pre-travel rabies vaccine series, the exposed traveler would need to get immediate medical care. Getting pre-travel rabies vaccine series allows more time to get to a trusted medical facility and decreases the number of treatment shots needed.

The bad news is proper treatment in many of these developing countries may be difficult to obtain. For this reason it is important to meet with a Travel Clinics of America physician before you go on the trip to make sure that you are protected.

Travel Healthy, Travel Smart, Travel Clinics of America

Dr. Alla Kirsch, M.D.

NOTE: It is extremely important to seek medical help whenever you are bitten or your skin is punctured by an unfamiliar animal. That animal should be captured and tested for rabies. If that is not possible the physician will most likely have to assume that you are infected and start the rabies treatment.

Question about Preventing Malaria

2009-06-22T17:19:00Z

Dear Dr. Alla,

I have been invited to goon a mission to Africa with my church youth group, and I have been advised that we may be traveling through a malaria infected area. What precautions would you advise?

Debra K.

Dear Debra,

Malaria is always a serious and sometimes deadly disease. However, the chance of actually getting malaria in Africa is 1 in 24,000. The peak risk period for getting malaria is February - May, however, malaria can be a problem anytime during the rainy season which starts in October.

Malaria is a disease transmitted by the bite of infected mosquitoes. Malaria symptoms can occur as early as 7 - 9 days after being bitten by an infected mosquito. Symptoms are flu-like; chills with violent shivering, a high temperature and sweating.

Other symptoms may include: headache, muscle aches, anemia, jaundice and fatigue. If you come down with flu-like symptoms during your trip, within six weeks - or even up to one year after your visit to a malaria area, seek medical help immediately and advise the physician of your travel history.

The following precautions protect against being bitten by a mosquito:

1. Take malaria tablets before, during and after the trip

Consult a Travel Clinics of America physician before your trip. The physician will review your medical history in order to determine what brand of malaria medications would be best for you because these medicines affect everyone differently. In addition, certain malaria pills are not effective in certain regions of the world. It is also important to review potential side effects when you meet with your travel medicine physician. For more information on available medications go to Travel Clinics of America, as well as contact information for travel medicine physicians.

2. Cover up, long sleeves, trousers, shoes and socks

Mosquito's are particularly active from dusk, through the night and during the early morning hours so it is important to make sure you are covered up. Mosquito's cannot bite through material, so it is important to wear long sleeved shirts, long trousers, socks and shoes. Exposed skin is vulnerable.

3. Carry mosquito repellent and apply it frequently

Apply mosquito repellent to any areas of skin that are not covered by clothing, particularly your hands and neck. Repellents that contain DEET will keep mosquitoes away, but need to be reapplied frequently because their protection diminishes over time.

4. Take along a mosquito net treated with insecticide

In malaria affected areas, most accommodations have mosquito nets already installed, but it might be a good idea to have one handy. It is important that these nets are treated with permethrin a residual insecticide. This treatment not only repels mosquitoes, but also prevents mosquitoes from biting through the material.

All of these simple precautions can dramatically reduce your malaria risk. Schedule a visit you’re your local Travel Clinics of America physician before your trip and make sure to travel healthy.

Travel healthy, travel smart, Travel Clinics of America,

Alla Kirsch, MD

NOTE: For more information regarding malaria, go to these articles by Michael Kirsch, MD. Also, TravelClinicsofAmerica.com has several articles of other travel related diseases, including: Yellow Fever, Hepatitis A & B, and swine flu (H1N1).

H1N1 Pandemic

2009-06-12T21:02:00Z

Dear Readers,

Pandemics are rare events and have only occurred 3 times in the past century.

Yesterday, the World Health Organization (WHO) has increasedthe H1N1 influenza pandemic level to phase 6, which is the final alert phase. In the U.S., the H1N1 virus has been reported in all 50 states. Worldwide, there have been nearly 30,000 cases including 144 deaths.

The H1N1 influenza, initially known as swine flu, has continued to spread in various regions of the world despite cautionary steps which led to this week's WHO announcement. The organization is not advising that travel or international business be curtailed.

The designation of pandemic does not suggest that the virus will become more deadly. WHO reaffirmed that most infected individuals have mild disease and recover fully.

The U.S. government is devoting $1 billion to develop an H1N1 vaccine. This fall, both seasonal influenza and H1N1 vaccinations may be advised routinely for most Americans.

While international travel is permitted, travelers should still be counseled on how to avoid H1N1 and other infectious diseases. This would be of particular concern to travelers who have chronic medical conditions.

Travel Healthy, Travel Smart, Travel Clinics of America,

Alla Kirsch M.D.

Question About Travel to Vietnam

2009-05-27T17:41:00Z

Ask Dr. Alla,

This coming fall I would love to travel to Vietnam. Can you give me any advice regarding health and safety while visiting this part of the world? Virginia A.

Dear Virginia,

I am so excited for you and a little envious too. From my research Vietnam is visually stunning, with a patchwork of green rice paddies, soaring mountains and beautiful beaches. And the food is fabulous--with over 500 Vietnamese dishes, dining out is an adventure.

Health Before you go, plan on visiting with a Travel Clinics of America physician. A Travel Medicine physician is your best source for information regarding travel vaccinations and travel diseases. Their advice is based on several factors; the time you plan to spend in Vietnam, the activities you hope to accomplish and your underlying medical conditions.

When packing your prescription medications, leave them in their original labeled container. It is a good idea to carry a letter from your physician describing your medical conditions and list of medications (including generic names). If you are carrying syringes or needles you must have a letter from your physician documenting their medical necessity.

Medical Checklist (just in case)Antibacterial cream, anti-fungal cream, antihistamines, decongestants, pain relievers/anti-inflammatory, anti-nausea medication, antiseptic for cuts and scrapes, contraceptives, insect repellent, a diarrhea 'stopper', indigestion medication, laxatives, steroid cream, throat lozenges, sunscreen and a hat.

I highly recommend that you carry a first aid kit with scissors, bandages, gauze, thermometer, safety pins and tweezers.

Insurance Do not leave the country without health insurance, accidents happen. If you have medical insurance, check to see if you are still covered when you travel to Vietnam. You may want to consider getting extra insurance.

Safety When you travel to Vietnam, it is important to be cautious about your safety. There are an array of scams and theft problems that I think are worthy of mention so that you can maintain a healthy skepticism.

1. Motorbike-rental scams. In short, beware of using the excellent lock that the owner insists that you use. Someone may follow you (with the proper key), steal the bike and then you have to pay for a new bike (as per your signed contract).

2. Motorbike-won't start scam. You have parked your rented motorbike in a 'safe' area protected by a guard. When you come back, it won't start. However, the guard knows someone who will repair the bike for US$10 (the mechanic that removed the parts in the first place will re-install them).

3. Your motel-of-choice supposedly has 'no vacancy', however a helpful taxi driver knows of a hotel with a vacancy. To avoid this scam, make your reservation ahead of time--by telephone or email.

4. Handbag and luggage theft. When you travel in Vietnam, do not leave anything dangling from your body (handbags, jewelry, cameras). Thieves on motorbikes may grab your personal items in a drive-by. Anything left unattended, even for a moment, may disappear.

5. Pick-pocketing. This activity often involves children, mothers and street vendors skillful a picking pockets or handbags. Even streetwalkers, looking for 'a good time', will approach Western men, give them a big hug--and then depart with their wallet and/or mobile phone.

As I stated before, maintain a healthy skepticism. Before you go, schedule a visit with a Travel Clinics of America physician and then relax and enjoy the Vietnamese experience. Despite all of these warnings, Vietnam is not any worse than what you would expect anywhere else.

Travel Healthy, Travel Smart, Travel Clinics of America

Dr. Alla

Question About Swine Flu in Mexico

2009-04-30T05:31:00Z

Dear Dr. Alla,

Dr. Alla, My family and I are planning a trip to Mexico (Cabo San Lucas) in June. Basically we are all in good health, however, my husband has high blood pressure and diabetes. Will the Swine flue affect our plans or my husbands health?

Lynn A.

Hello Lynn,

There’s no question that the swine flu outbreak, which started in the Mexico City region, may change your itinerary. We do not know what the swine flu risk will be in Mexico - or in other parts of the world - in the coming weeks and months.

The U.S. government has advised against any leisure trips to Mexico at this time. If you were to travel there now, you could end up bringing home an unwanted souvenir – swine flu!

Thousands of Mexicans are now ill and many thousands more may be infected, but are not sick yet. These folks, however, can still transmit the virus to others. The crisis in Mexico may worsen significantly in the near term.

For now, I think that you have time to monitor the situation closely, but you may end up choosing another destination or postponing the trip.

As always, before you leave for any trip, schedule a visit with the nearest Travel Clinics of America physician.

Travel Healthy, Travel Smart, Travel Clinics of America

Dr. Alla Kirsch, M.D.