Anna King, globetrotter and medical professional, has kindly written an in-depth guide to staying healthy and identifying and treating illnesses and injuries while travelling. She’s covered common complaints and their treatments, first aid, coping with long-distance flights, and a whole lot of handy tips. Keep this info on-hand for your horse riding holiday!
Common Medical Complaints and Effective Treatments
Maintaining hydration through any illness is important, but it becomes critical with gastrointestinal upsets.
- Oral hydration solutions or tablets such as hydralyte or gastrolyte are essentials. Take one dose after each loose bowel motion.
- Avoid alcohol and sugary drinks. Watered down Gatorade or similar sports drinks are sometimes okay in a pinch.
- If diarrhoea lasts more than 48 hours in an adult or 24 hours in a child, or is severe, see a doctor.
- “Stopper”: Loperamide 2mg/Gastrostop/Imodium
Use only when diarrhoea is inconvenient. Loperamide paralyses the bowel, it is NOT a cure and may make diarrhoea worse if taken for prolonged periods. Take 2 capsules at once, then one after each loose bowel action. DO NOT take if there is any blood in the bowel motions.
Antibiotics are used when you have more than 4 watery bowel actions in less than 24 hours and you feel generally unwell, e.g. nausea, abdominal cramps or fever. Take 2 tablets together with 1 Loperamide tablet. If you are better in 12 hours, no further treatment is required. If not, take 1 Norfloxacin tablet every 12 hours for 2 more days. Seek medical advice as soon as possible, especially if you have been or are in a Malaria area.
- Azithromycin 500mg
A useful alternative medication in South East Asia and places where Norfloxacin resistance may occur. Take 1 tablet daily for 3 days, or 2 tablets as a single dose.
- Tinidazole 500mg
Giardia usually presents with mild, foul smelling, persistent diarrhoea for one week or more. Usually khaki or pale-coloured motions (may float), flatulence, burping ‘rotten egg gas’, abdominal bloating, loss of appetite and tiredness. Giardia may also cause a dairy intolerance, which is usually temporary. For the presumptive treatment of Giardia, take 4 Tinidazole tablets (2 grams) with a meal, once only. Avoid alcohol for 24 hours.
Amoebic dysentery usually presents with bloody diarrhoea, fever, abdominal pain and weight loss. Often hard to distinguish from bacterial diarrhea. IF Norfloxacin has failed, try 4 Tinidazole tablets (2g) with a meal for 3 days.
- Buscopan (Hyoscine butylbromide 10mg): Antispasmodic. Take 2 tablets up to 4 times a day. If pain persists see a doctor. Make sure you treat the underlying cause.
It is easy to forget about drinking enough water when you are travelling. Some people also find sitting for a long time on long haul planes/train/buses will cause constipation. For some it can be as simple a problem as a change of diet that upsets the delicate balance.
- Stay hydrated and aim to get more exercise.
- Foods such as pears, prunes and kiwi fruit all help keep the bowel moving (pear and prune juice also works).
- Otherwise: Coloxyl and Senna – 2 tablets morning and night can get things moving. This should only be a temporary solution. If symptoms persist, see a doctor.
Most travellers vomit because they have ingested something toxic that needs to be expelled. Let your body rid itself of this first (you probably won’t keep any tablets down anyway). Once you have emptied the contents of your stomach, then you can take anti nausea medication.
- Metoclopramide 10mg (Maxalon): 1 tablet every 8 hours. Max 30mg in 24 hours. May cause dizziness.
- Prochlorperazine (Stemetil) 5mg: 1 tablet every 6-8 hours. Max 20mg in 24 hours. This drug is excellent for motion sickness if taken 30 minutes prior to travel.
- Ondansetron 4mg wafers (Zofran): 4-8mg under the tongue up to 3 times a day (Max 32 mg in 24 hours). Once reserved for chemotherapy patients, this drug is slightly more expensive, but worth it, as it only needs to be dissolved under the tongue rather than swallowed. It is also safe for children in a 0.2mg/kg dose (i.e. 2mg or half a wafer for a 10kg child).
Antihistamines will dry the nose and clear the eyes. They will also help with itching due to skin allergy, contact dermatitis or insect bites. They are good for mild allergies but completely inadequate in an anaphylactic reaction.
Loratidine 10mg (Clarityn): 10mg Daily. Suitable for children: 2.5mg <12Kg, 5mg (12-30kg).
Fexofenadine 120mg or 180mg (Telfast): 180mg Daily or 60mg 12 hourly. Suitable for children: 30mg 12 hourly (6-11yo).
Promethazine 10mg or 25mg (Phenergan).
Anaphylaxis is a life threatening situation and requires immediate medical attention. It can develop over minutes to hours from exposure and escalate exceptionally quickly. Though it may start with relatively mild symptoms such as an itchy, red rash, localised swelling or a scratchy throat, it can quickly progress to tongue or throat swelling, wheeze, shortness of breath, loss of airway and life threatening low blood pressure. Severe anaphylaxis may result in cardiac arrest.
- Immediately remove any suspected trigger and call for help (an ambulance, ideally)!
- If possible, lie the patient flat and elevate the legs. (In some cases, if the symptoms are more breathing related, Patients will feel more comfortable sitting up.)
- If known anaphylaxis, administer Epipen. People with known Anaphylaxis should always carry an up to date Epipen.
The only effective treatment for anaphylaxis is ADRENALINE and fluid resuscitation. Whilst antihistamines may treat mild symptoms such as rash, itch and localised swelling, they are of no benefit in a true anaphylactic situation and may even compromise the patient if a drowsy antihistamine such as Phenergan is used. Steroids are also not beneficial in an acute anaphylactic situation. However, they may be recommended as part of the secondary management once the initial anaphylactic reaction has been stabilised.
Upper Respiratory Tract Infections (URTIs)
Most upper respiratory tract infections (URTIs) such as the common head cold are viral and require supportive treatment rather than antibiotics. Regular paracetamol, plenty of oral fluids and rest will get you through most viral infections. Symptoms are usually worst at 3-5 days and generally last around 5-7 days.
A true influenza will generally feel very different to an URTI as symptoms are not confined to the head. Symptoms may include: fever >38℃, headache, feeling weak and tired, muscle aches and pains, conjunctivitis, nausea and vomiting. Spread is by droplets (coughing and sneezing sprays doplets in the air). It is highly infectious and spreads rapidly. Once in the system, it usually incubates for 1-4 days before becoming apparent. People are infective usually 1 day prior to symptom onset and for 7 days after symptoms have started.
Most people feel generally unwell for a good 7-10 days before they notice some improvement. The Fluvax may not stop you getting the flu (viruses mutate very quickly and it is hard to keep up), however, it should shorten the duration and lessen the severity of the flu if you do get it. It may take 2-3 weeks before you feel back to your old self.
The main concern with influenza is the rate of secondary complications. Increasing shortness of breath or difficulty breathing, confusion and a decreased level of consciousness should all be investigated by a doctor.
Oseltamivir (Tamiflu) is only useful if given in the first 48 hours and will only shorten the duration by a day. The main use is to decrease the risk of complications as well as decrease the infectivity and onward spread of the virus. The best treatment for the flu is paracetamol and/or ibuprofen, fluids and rest.
Strepsils or anything similar will help soothe your throat. You can even gargle dissolvable aspirin to help reduce the inflammation if you are desperate.
Sinus congestion often occurs with viral infection or allergy and rarely requires antibiotic treatment. However, flying with a sinus infection or nasal congestion can be exceptionally painful. It is best to try and clear the sinuses with copious amounts of salt water nasal spray. Failing that, nasal decongestants will temporarily assist and enable you to fly or travel with less discomfort.
- Oral decongestants (Psuedoephidrine) e.g. Sinus Pain Relief or cold and flu tablets.
- Nasal Decongestants (oxymetazoline, tramazoline or xylometazoline) e.g. Drixine nasal spray.
- Paracetamol 500mg, 2 tablets (1g) every 4-6 hours (max 8 tablets or 4g in 24 hours). Useful for mild pain or fever. Still useful in severe pain as it helps increase the effectiveness of the stronger pain relief. Generally safe and well tolerated when used at the correct dosage. Overdoses are serious. Do not use if you have a history of liver disease.
- Ibuprofen 200mg, 2 tablets (400mg) every 6-8 hours with food or milk (max 6 tablets or 1200mg in 24 hours). Anti-inflammatory used for mild pain relief and fever. Ibuprofen should only be taken for 3 days at the most and should not be taken if there is a history of stomach ulcers, kidney disease or asthma. (Some asthmatics can take ibuprofen safely. However, if you haven’t tested it prior to travel, it’s best not to risk it.) Must be taken with food or milk, as it can cause gastric irritation and stomach ulcers. Not to be taken unless well hydrated as this can affect the kidneys.
- Paracetamol and Ibuprofen act via different pathways and can be safely used together to improve pain relief and manage fevers. If pain or fever persists, you should see a doctor. Paracetamol is usually taken at 06:00, 12:00, 18:00 and 24:00 with Ibuprofen at 06:00, 14:00 and 22:00.
It is often useful carry a course of antibiotics with you, especially if you are travelling in rural/remote areas where access to medical facilities may be limited. Usually they cover bronchitis/chest Infections (fever over 38.3 ℃ plus coughing up green phlegm), sinus infections (headache, fever and copious green mucous from the nose and down the back of the throat) and middle ear infections (earache plus fever).
- Roxithromycin 300mg daily for 5 days. Can cause nausea, diarrhoea and stomach pain in some people. Do not take if allergic to Erythromycin.
- Amoxycillin 500mg every 8 hours for 5-7 days (Children 15mg/kg).
- Amoxycillin+Clavulanic Acid 875+125mg (Augmentin Duo Forte) 1 tablet twice a day with food for 5 days. (Children 22.5+3.2mg/kg). This is covers a broader spectrum of bacteria than Amoxycillin and should be used if there is no response to the Amoxycillin.
- Doxycycline 100mg 12-hourly with food or milk for 5 days.
- Cellulitis: If left untreated, even small cuts and scratches can quickly escalate into serious skin infections or even blood stream infections if left untreated, especially in a tropical area. Treatments include Flucloxacillin and Roxithromycin.
- Fungal Infections: Fungal infections are particularly common in tropical and sub tropical climates. Antifungal: Clotrimazole (Canesten). Apply sparingly to affected area three times a day, rubbing in gently. Wash hands thoroughly after use. This is useful against tinea, ringworm and external genital thrush. Pessaries may be used for vaginal thrush.
- Stings/Bites: Stingose Gel or pine tar. Apply promptly and liberally to all affected areas. Reapply if necessary. Avoid contact with eyes.
Otitis Externa (Swimmer’s ear)
If it hurts when you tug or bump your ear, this is usually an indication of otitis externa rather than a middle ear infection. This may require Sofradex (Dexamethasone/Framycetin/Gramicidin): 3 drops, 3 times daily for 3-7 days.
Eye infections (Conjuctivitis)
Most mild conjunctivitis is usually allergic, irritant or viral in nature. More severe symptoms such as significant pain, loss of vision or photophobia (sensitivity to light), indicate acute keratitis or another serious disorder that requires immediate medical attention.
Viral infections usually resolve with supportive treatment (Liquid tears, cold compresses, phenylephrine drops and light avoidance and simple pain relief such as paracetamol).
Bacterial conjunctivitis usually spontaneously resolves after 5 days but may last up to 14 days if untreated. Treat with Chlorsig 0.5% eye drops: 1-2 drops each eye every 2 hours initially, decreasing to every 6 hours as the infection improves. Chlorsig ointment may also be used on minor wounds as an antibiotic ointment. Chloramphenicol 1% eye ointment may be used at night.
Firstly, any dental problems should be dealt with prior to travel. Dental work is expensive at the best of times and you don’t want to be caught out overseas. Antibiotics should be considered when the infection has spread beyond the local confines, causing swelling and systemic symptoms.
- Amoxycillin (as above).
- If unresponsive, add Metronidazole 400mg every 8 hours or alternatively change Amoxycillin to Augmentin.
Any spread of the infection to the upper neck or airway requires urgent medical review.
The first problem any overseas traveller usually encounters is adjusting to time zones. This is a process that should begin with being well rested prior to departure and then adjusting your sleep time on the plane to the time zone you are entering.
- Temazepam: 10mg at night. Short acting sleeping tablets may be useful while adjusting to new time zones but should not be taken at high altitude as they will worsen altitude sickness.
- Melatonin: 1-2mg at night. Whilst only available with a script in Australia, Melatonin is available over the counter in some countries (including the USA). Melatonin is a naturally occurring hormone which helps regulate the natural sleep-wake cycle. Supplemental melatonin assists with the insomnia associated with jet lag.
Long-haul flights can come with a number of issues: dehydration, leg swelling, abdominal bloating, jet lag and blood clots in your legs or lungs (DVTs/PEs).
- Stay hydrated. Drink plenty of water and try to avoid carbonated drinks as the gases expand with ascent, leading to bloating. Avoid caffeine or alcohol in flight as it will worsen jet lag and dehydration.
- Use plenty of moisturiser, especially on your face and exposed areas of skin.
- Wear glasses instead of contacts if possible. Use lubricating eye drops if necessary.
- Sleep on the longer sections of the flight and try to time it with the time zone which you are entering rather than the one you are leaving. It is best to be as well rested and relaxed as possible prior to a long flight and ensure that you get a good night sleep the night before. Stopovers also help. Jet lag is generally said to be worse when travelling to the east.
- Eat light, easily digestible meals and avoid fatty and high-carbohydrate foods. Gaseous distension on ascension will lead to abdominal bloating and discomfort. Those with problematic bowels may need to use a mild laxative.
- Regular walks around the plane and airports during stopovers are essential and help with leg swelling, back pain, digestion and preventing Deep Vein Thrombosis and Pulmonary Embolism. Compression stockings will help decrease leg swelling and the risk of DVT/PE, as will regular leg exercises whilst sitting in your seat, around the aircraft or at the airports.
- Wear loose, comfortable clothing and footwear.
- If you have a cold or sinus problem, you will likely experience ear or sinus pain with the pressure changes during the flight. A nasal decongestant spray prior to take off and landing is recommended. This will help with the symptoms but usually not the underlying problem. In the days prior to flying a saline nasal spray is recommended to try and clear the sinuses. Up to 10 sprays in each nostril, block your nose and try to “pop” your ears then block the same nostril and try to blow it out the other side (a teaspoon of salt in a bowl of warm water then using your cupped hand to snort up the salty water is equally effective). Sounds disgusting but this will hopefully decrease the risk of pain and a burst ear drum.
After You Arrive: Drinking and Eating Safely
Good hand hygiene is the most important thing to remember when travelling, but there are a few other tips that will help minimise your risk of getting sick during your trip.
- Water brought to a rolling boil for 1 minute is safe.
- Bottled water is also safe if the seal is unbroken and there are no needle punctures in the lid.
- Modern water purifiers are effective.
- Chemically disinfected water is safe if the instructions are followed correctly. It will not work if the water is cloudy or contaminated with organic material (this is when a water purifier is more effective).
- Cans of soft drink/beer, especially international brands, are generally low risk. However, beware of drinking from the can as they are often stored in areas where rats and other animals can pee on the rims.
- Avoid ice (and no, the alcohol will NOT kill the germs in the ice!). Freezing actually preserves the germs.
- Presume all other sources of water are contaminated. Use bottled water or another safe source when brushing your teeth. Don’t open your mouth when swimming in any water.
- Avoid uncooked, undercooked and reheated food or food that has been sitting out exposed to flies.
- Avoid eating salads or unpeelable fruit and vegetables. Washing in vinegar may decrease some but not all of the risk.
- Ice cream and dairy products, unless internationally packaged, are usually unpasteurised and may carry bacteria such as salmonella, E. coli and listeria.
- Avoid raw or shelled seafood: this includes oysters, clams, mussels, prawns and mudcrab as these also carry increased risks.
- Try to avoid dishes that require a lot of food handling during preparation.
- Feel free to eat freshly cooked food and food you can peel or prepare yourself.
- Keep to well patronised, busy restaurants serving local food. The turnover is high and the food is more likely to be fresh. Eating beef or pork in countries where that meat is not commonly eaten for religious reasons is usually asking for trouble. Clean plates and cutlery are also important.
- Avoid eating large carnivorous predator fish in the tropical and subtropical areas (barracuda, spanish mackerel, mullet, sea bass and shark). Ciguatera fish poisoning is a problem in the Indian and Pacific oceans as well as the Carribbean. The ciguatera toxin accumulates in the older, larger reef fish via the food chain. The fish will look, taste and smell normal and cooking will not destroy the toxin. The symptoms are often sadly mistaken for food poisoning with fatal results.
- Avoid mahi mahi, mackerel, marlin, bluefish, amberjack and abalone. Scomboid poisoning can be caused by eating fish which have not been refrigerated properly. It often presents with allergy like symptoms due to bacteria in the fish releasing histamine.
- Consider getting the Cholera vaccination. It has the added benefit of covering E. coli, one of the most common causes of tummy bugs.
Suprisingly for some, accidents are the main cause of health problems whilst travelling. Common sense and basic safety procedures can go a long way to preventing unnecessary, costly and sometimes, devastating accidents. Not all countries will have the same safety precautions or laws as Australia. Applying the same rules from home to your travel, will help maintain your safety. Road accidents and drownings are two of the most common causes of accidental death.
A first aid course is useful wherever you go, even at home. It is especially useful if you are travelling in remote places, far from medical care.
The DRS ABC is the mainstay of a rapid responder.
- DANGER: Stay calm and assess the danger to both yourself and the injured person. You cannot help anyone if you get injured yourself.
- RESPONSE: Ask the person if they are okay. Can they respond to your voice or a very hard squeeze to their upper trapezius (the muscle body between your neck and shoulder)?
- SEND for HELP: Call for bystander assistance (ask for any doctors, nurses or first aiders preferentially) and get the person closest to you to call Emergency Services. They need to be near you and stay on the line so you can provide details and listen for further instructions. Dial:
- 000 in Australia,
- 911 in the USA,
- 999 in the UK,
- 112 in Europe.
If the person is unresponsive, you will need to proceed to ABC:
- Clear the airway of any food, fluids, foreign bodies or loose dentures. Beware of the neck. Try to move it as little as possible in case of Cervical spine injury.
- Check to see if they are breathing. If they aren’t you should proceed to “C” and prepare for CPR/mouth to mouth resuscitation
- Check for a pulse. Most people will automatically check for a radial pulse at the wrist but you should check central pulses such as the neck or groin.
- If there is none, commence CPR.
- 30 compressions fast and hard, 1/3 of the chest depth (use your whole body weight) to the tune of “Staying Alive”, then 2 breaths. Aim for 100-120 compressions per minute.
- CPR is exhausting. Have bystanders on hand to rotate with you. Get someone else to do the breaths. Survival rates are best when there is minimal interruption to chest compressions.
If you are lucky enough to have an Automated External Defibrillator handy, attach the pads as shown and follow the automated instructions. The Australian Resuscitation Council (resus.org.au) has handy flowcharts you can refer to if circumstances permit.
Never underestimate the benefit of a First Aid Kit on hand when you are travelling.
Small wounds can easily become infected, especially in tropical areas. All wounds, even small ones and especially coral cuts, should be cleaned with clean water or saline (1 teaspoon of salt to 200ml boiled water). Make sure all the debris is cleaned out and give the wound a good washout. ‘Dilution is the solution to pollution’: sheer volume of washout is sometimes the only answer.
- Once clean, apply a smear of antiseptic (e.g. Betadine) and cover with a waterproof dressing.
- Try to keep the wound covered for at least 3 days before changing the dressing.
- Increased pain, swelling, redness or discharge can indicate infection and further medical attention should be sought.
- Use ice water to cool immediately. Heat is contained within the tissue and will continue to burn even after the source of the burn has been removed. Immediate application of ice water will help decrease the ongoing damage to tissue. If using an ice pack, wrap in a cloth to prevent the ice sticking to skin.
- Don’t attempt to remove burnt clothing as it is often stuck to the skin. Remove jewellery/rings/watches immediately.
- Burns exposed to air are painful and prone to infection. They should be covered with a non stick dressing and dressed daily. Blisters should not be popped.
- Pain relief and extra fluids may be required.
- Seek medical help for burns to the face or hands, if the burn is larger than the palm of the person’s hand or if it doesn’t hurt (this suggests a full thickness burn).
- Infections are common complications of burns. Increased redness, pain or fever can indicate infection and will require medical attention.
- Wear disposable gloves for your own protection
- Apply firm pressure with a sterile pad/gauze for up to 3 minutes to the centre of the wound or on the heart side of the wound. Keep applying pressure until bleeding stops.
- Don’t remove large embedded objects as this may worsen the bleeding.
- If possible, elevate the wound above the level of the heart.
- Nose bleeds: lean forward and place pressure over the upper nostrils and an ice pack over the bridge of the nose. If bleeding doesn’t stop after 15minutes then medical attention should be sought. Tampons can be useful in some circumstances.
Sprains and strains
- RICE: Rest Ice Compression and Elevation are the mainstay of treatment
- Ice (20mins of ice on and 20mins off) especially within the first 24-72hours, can dramatically decrease swelling and aid healing.
- Elevation above the level of the heart will help decrease swelling and therefore pain.
- Compression of the injured area will provide gentle support and help minimize swelling. Bandages should go from well below the injured area, up the limb to well above the injured area. Tubigrip is also exceptionally useful.
- Obvious deformities, excessive bruising, nerve involvement or inability to weight bear are all indications to seek medical attention.
- Ticks should be removed by the head with splinter forceps, taking special care not to squeeze the body of the tick as this will inject more of its body fluids into the patient.
- Most spiders aren’t poisonous. Spiders should be caught if possible to aid in identification.
- Scorpions are usually active at night but like to hide in shoes or under rocks during the day and only sting if disturbed. Whilst painful, the sting is not poisonous.
- Snake bites should ALL be treated as poisonous (most are not). Don’t try to catch the snake as more people tend to get bitten this way. Do take notes on its shape of head and nose, any patterns or markings and its rough size.
- Keep the person calm
- Apply a pressure bandage to limit venom spread into the lymphatic system (not to cut off blood supply), as tight as you would for a sprain. Start at the lower end of the limb and work up towards the heart. Mark an X on the bandage over the bite site if possible.
- Immobilize the patient if possible. Otherwise, use a splint and immobilize the joints either side of the bite at the very least.
- Dog, Cat, Monkey or other animal bites, especially in Rabies endemic areas, should be washed with copious amounts of soap and water for at least 5 minutes without scrubbing. Medical attention must be sought IMMEDIATELY for a post-bite rabies vaccination course even if you have had a pre-departure vaccine. Time is of the essence as there is no cure for rabies one the infection takes hold.
Sexually transmitted infections such as gonorrhea, syphilis, chlamydia, HIV/AIDs, Hepatitis B, herpes simplex and genital warts are increasingly common. Consistent and correct use of condoms remains the mainstay of safe sexual practice. However, whilst condoms prevent body fluid infections, they do not always protect against infections spread by direct skin contact, such as herpes and warts. Although HIV is the most serious of the STDs, other infections may have long term consequences such as pelvic inflammatory disease and infertility.
Changing time zones can be difficult and may cause irregular bleeding. It is usually best to keep to home time for taking the oral contraceptive pill whilst in transit, then gradually adjust to a convenient local time. Never be more than 12 hours late taking the combined oral contraceptive pill (3 hours with the mini pill).
Diarrhoea, vomiting, antibiotics, high dose Vitamin C (in some jet lag pills) and missing a pill by more than 12 hours can all render the pill ineffective. In such cases, apply the ‘7 day rule’: use condoms for the duration of the illness/antibiotics and until 7 active hormone tablets have been taken.
Periods can be skipped for convenience whilst on the pill, especially if access to sanitary products or facilities are limited.
Oral contraceptive pills increase the risk of blood clots in the legs or lungs. Any pain and swelling in the lower limbs should be investigated.
When you return
If you seek medical help anytime in the next 12 months after your return, it is important to disclose any overseas travel history. In some cases, it is also important to inform your doctor if you have travelled locally (eg if you have visited the Tropics in Australia) as there are different diseases that they may need to consider.
You should see your doctor for any flu like illness (fever, shivers, headache, muscle aches, diarrhoea or vomiting lasting more than 24hours) that begins 7 days after entering, and for up to 12 months after leaving, a malarial region. Regardless of whether malarial prophylaxis drugs have been taken, this should be presumed to be Malaria until blood tests prove otherwise.
That’s it! Simple, right?!
Hah hah hah.
It sure is a lot of information to digest, but I know I learned at least a dozen new things thanks to Anna! If you don’t feel prepared after reading this, you probably never will – but at least you’ll know how to keep yourself safe and healthy, and what to do if something goes wrong! Thanks again to Anna for compiling these amazing health resources – may they help many a globetrotter have an amazing horse riding holiday.
Images via Pixabay.