I am not much of a traveler but I recently had a chance to take a short vacation to the lovely city of Cancun, Mexico. It came as a bit of a surprise to find out that Cancun is not a suburb of Miami and that I needed my passport to get around. My wife and I arrived without a hitch, except for the fact that I played the role of the dedicated doctor and let my wife to do all the packing. I did find out that it is dangerous to one’s health not to help with the packing. Except for that hazard of the briefly annoyed spouse, I was off to a safe start.

The beach was great. However, there were a few health risks that caught my attention. One was the water activity of parasailing. I was a very nervous physician as I watched the event unfold on an otherwise quite safe looking beach complete with the warm sun and the gentle breeze. However, I was not fooled one bit by Mother Nature. I knew there was trouble brewing. A pair of Mexicans bearing an uncanny resemblance to the semifinalists of the TV reality show Wresting with Morons invited a very “healthy” lady (i.e. over 300 pounds) onto a boat, strapped her in a harness and let flow a huge parachute as the boat lumbered then cruised in the surf one hundred yards off shore. The parachute filled and the lady was airborne in her harness but only for a short while. There are a few laws of physics that the Mexican ministers of parasailing had failed to heed. The speed of the boat times the mass of the lady divided by the circumference of the parachute equaled one thing: The lady spent a lot of time in the Gulf and drank her share of water as well. After a few clinically recognizable screams for help from the lady, the flight efforts contrary to the best ideas of Sir Isaac Newton were abandoned much to the relief of the now not-too-enthusiastic audience on the beach.

Advice No. 2, when considering beach fun, check out the credentials of the folks selling the game (i.e. ask the hotel rep what the body count was last year on the parasailing front.). A close third in my travel advice relates to the food. More specifically, I am talking about the water. The most important determinant of risk for a water-borne infection (aka Montezuma’s Revenge or Traveler's Diarrhea) is the destination. Mexico, Latin America, Africa, Asia, and The Middle East are likely sites associated with the development of a diarrheal disorder due to ingestion of contaminated water. The water may be that from which shellfish are harvested or that used to wash fresh vegetables and fruits as well as the drinking water. The Centers for Disease Control reminds vacationers that “Travelers Diarrhea” (TD) can be largely prevented by following this rule: “boil it, cook it, peel it, or forget it.”

TD is the commonest illness affecting travelers. Each year 20-50% of international travelers develop diarrhea. We are talking about ten million travelers who contract what is usually a 1 to 5 day illness associated with cramps, nausea, perhaps vomiting, bloating, and fever caused most commonly by the bacterial pathogen E. coli. Persons with diabetes, diseases of the intestines, immunodeficiency disorders, or who are taking anti-acids or other anti-ulcer medications (Protonix, Aciphex, Zantac, etc) are at increased risk for this common, unusually not life-threatening, self-limited disorder. Beyond the preventive measures suggested by the CDC rule, the disorder can be prevented by taking 2 Pepto-Bismol tablets four times per day for up to two weeks or by taking a once-a-day antibiotic tablet. While the former program is more cumbersome, it is preferred over taking an antibiotic solely for preventative purposes as side-effects and promotion of drug-resistant strains of bacteria often accompany such use of antibiotics. It is still a good idea to carry a seven-day supply of a recommended antibiotic (Cipro or Levaquin) along with some Imodium for when the disorder actually strikes. Usually, these drugs plus a liquid diet and some rest will have you back in the parasail program in no time. If fever, bloody diarrhea, or profound weakness develops, medical attention will be required. The principals of treatment, either self-directed or by a medical team, are the same – hydration, antibiotics, and comfort measures until the disorder subsides within 3-7 days.

I hope you have a chance to travel soon. Remember these simple rules to protect your health: watch out for the locals, watch out for the water, and certainly help with the packing. >