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Travelers' Advisory

When in Rome, where your health is concerned, you may not want to do as the Romans do -- and without travelers' insurance, you might not be able to, for that matter. When going abroad this summer, a little advance planning can go a long way to help you sidestep disaster, diarrhea -- and sheer rage.

By Jeanie Lerche Davis
WebMD Feature

Reviewed By Charlotte Grayson

Italy, Machu Picchu, Malaysia -- it's summer travel season, and the sidewalk cafes, the fabled lost cities, the exotic nightclubs are hard to resist. But travel isn't without its headaches, and life isn't without its medical disasters. Are you prepared for a broken leg in Bangkok? Gallstone surgery in Genoa? A midnight face-off with Montezuma?

Face it: If traveling doesn't get you in your wallet, it'll get you in your head, your heart, your veins, or your stomach. Here's advice to help you circumvent the worst of worst-case scenarios.

Cover Yourself -- With Insurance, That Is

It's a scenario you think far-fetched, until it happens to a family member. Eileen and a few sorority sisters were in the last days of their Acapulco spring break vacation -- cruising the sites in a rental jeep -- when a truck hit them head on. They were lucky to be alive. She woke up in a local hospital and was told she had two broken arms and a broken collarbone -- though no X-rays or CT scans were taken.

But Eileen has a savvy daddy. Just months before her accident, he bought travel medical insurance for the whole family. It's a special type of policy that can be purchased on an annual or per-trip basis -- and depending on the policy, covers a gamut of travesties including lost luggage, trip cancellations, and medical emergencies.

Type "travel medical insurance" into any search engine, and you'll help find all sorts of similar policies. One offers 13 different variations, including one called ExPatriot-Plus for U.S. Citizens. The policy covers six months of travel, emergency evacuation, and air transport to your home country for $200-$300, depending on the deductible you choose.

But when sizing up such policies, ask lots of questions, says Phillip Morris, executive vice president of MEDJET.

"Will they bring you to your hospital of choice -- say, in your hometown -- or will it be the closest U.S. hospital to the border you're crossing? And if you have a medical emergency in the U.S., will you still have the option of being transported to the hospital back home?"

Eileen got back to her hometown hospital -- her parents' choice -- the very next day. "The other girls had another policy ... they were there until the next week and were evacuated to Houston.

Attacking Montezuma's Revenge

A bad case of diarrhea can be your worst travel nightmare, but here's one possible preventive. A dietary supplement called probiotics is now on health food store shelves, and is widely touted to provide your gastrointestinal system with Lactobacillus reuteri cells -- which might help stave off diarrhea.

Europeans have been taking the stuff for years, says Steven Peikin, MD, of Cooper Health System in Camden, N.J. "If you lived in Scandinavia, you wouldn't think about going anywhere without taking your probiotics," he tells WebMD.

Probiotics help maintain a healthy balance of "friendly" bacteria in the digestive tract, says Peikin. "Probiotic bacteria can squeeze out any pathogenic bacteria your body gets exposed to -- like bacteria that cause traveler's diarrhea, antibiotic diarrhea, yeast infections, possibly even food poisoning."

The pill form marketed as "Probiotica" is a concentrated dose that contains some 100 million bacteria cells. "The key to protection is getting lots of cells," Peikin tells WebMD.

Start taking probiotics for at least one week before your trip, and continue at least one week after your trip, he advises. "Really, you can take it any time. You never know when you might get some bad bacteria, especially if you're going to be traveling, eating out a lot, going to be on antibiotics, or just for general health benefits. You may be improving your immune response at the same time."

Note: Even though probiotics may prevent diarrhea, you can't always count on it, says Peikin. "You still have to adhere to the usual principles: avoiding water, ice, fruits. This is an extra insurance policy."

Vaccine for Traveler's Diarrhea

A promising diarrhea vaccine is also in the works. Like a triple-scoop ice-cream cone, this vaccine is designed to protect against shigella, campylobacter, and E. coli bacteria.

"It looks very good, very promising," Stephen Keith, MD, tells WebMD. In early clinical trials, the vaccine has proven effective in generating an immune response against shigella and campylobacter. More trials will show whether it actually provides protection.

If the entire vaccine receives FDA approval, it will likely be a pill taken for two weeks before departure and would provide protection against most bacterial causes of traveler's diarrhea, says Keith.

"This is a big deal," Keith tells WebMD. "So many people have the story of spending their whole vacation looking at the beach vs. being at the beach. We're talking about some 25 million Americans."

Complaining 101

Sometimes, just getting to your travel destination can be the biggest disaster you encounter. Flight cancellations and long delays -- in the airport, on the tarmac -- have created something called "air rage." It's a ratcheted-up version of "road rage," says Nadine Kaslow, PhD, professor and chief psychologist at Emory University School of Medicine in Atlanta. At its core are anger and frustration.

Kaslow logged 30-plus trips last year alone and knows only too well the frustrations that air travelers face. A few years ago, she nearly missed a long-awaited Alaskan cruise when a flight to the West Coast was canceled.

"I'd been planning it for a year, laid out all this money. It was one of those nightmare situations. I ended up taking seven plane trips to different little towns in Canada so I could get there and not miss the boat," she tells WebMD.

The anger you feel is understandable, says Kaslow. "But getting out of control, becoming so frustrated that you take it out on flight attendants, on people who are not really responsible -- that's what's not acceptable."

The frustration escalates when people are stuck in the plane -- and especially if passengers have been drinking, Kaslow tells WebMD. "People become less inhibited, more impulsive. And I think they have a real sense of entitlement, a feeling that they're special and that these things shouldn't happen to them. Frequent flyers really seem to feel this."

To control anger, Kaslow advises:

  • Plan for problems. "Bring something to entertain yourself like a game, books, food," she says. "If you know you're going to need different clothes when you arrive, put them in a carry-on bag."
  • Talk to people next to you on the plane. If they can't relate, who can?
  • Do as much problem-solving as possible. "If it's possible to get rebooked, get your cell phone out or go to a pay phone -- even if flight attendants or gate personnel are offering to make the reservations for you," Kaslow says. "Sometimes they will even advise you to do the same thing."
  • Spend your time writing a letter to the airline, says Kaslow. "I certainly know plenty of people who have gotten complimentary tickets, had $30 taken off their next flight. It won't fix your current situation, but it might make you feel more in control."

Airline personnel could also be more forthcoming with information, she says. "I've thought about this a whole lot. People feel helpless. And if they don't know what's going on, the angrier they get. If they keep people informed, it gives them a sense that someone is trying to take care of the problem."

Words of Wisdom

Planning is everything, say the travel experts. And if making connections makes you crazy, here's one more tip: "Make your plans seamless," says B. J. Ferdinand of Wise Traveler travel agency in Atlanta. Example: "If you're trying to make a flight connect with a cruise departure, buy your airline tickets through the cruise line. Then if something goes wrong, you've got some support."

"For heaven's sake, buy travel insurance," she advises. "If your plane is delayed, the insurance can take care of you. And the airlines do have to take responsibility."

Then: "Once you've taken care of all the things that could possibly go wrong -- the ones you can think of, anyway -- just relax," she says.

"Remember," says Ferdinand, "this is a vacation. You don't really have to be there at a specific time. Just show up and relax."

Originally published June 18, 2001.

Medically updated May 17, 2005.

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Last Editorial Review: 5/19/2005 2:20:28 PM