The motion sickness Some of you will get...

dr. Peter Felkai: Travel Medicine

Dr. Felkai PDr. Felkai Pééter ter PhPh.D..D.headhead of of department department

Travel Medicine ChairTravel Medicine Chair

Travel related illnessesTravel related illnesses I.I.

The The pathogen factor the pathogen factor the trip itselftrip itself ((„„realreal””travel illnessestravel illnesses ))

TRAVEL RELATED MEDICAL TRAVEL RELATED MEDICAL ILNESSESILNESSES: : HOW SERIOUS THE HOW SERIOUS THE

PROBLPROBLEM ISEM IS??

TRAVELER’STRAVELER’S49% – 59% had medical problem during the trip

• 26% - 18% sought doctor’s advice or visit the office• 5% being hospitalised abroad• 48% need further medical treatment at homeland• 6% needs sick pension after return*

* ISTM Professional education and Training committee: Introduction to Travel

Medicine (oktatási power-point prezentációs segédanyag), 2. kiadás, 2008

TRAVEL RELATED MEDICAL TRAVEL RELATED MEDICAL PROBLEMSPROBLEMS

Before trip: preexisting (chronic)diseases, acute illnesses

During the trip: travel-related medical problems

After returning home:emerged inferctions,travel, convascelence ofmedical problem during trip

Dr. Felkai Péter: Utazásorvostan

TRAVEL RELATED ILLNESS:TRAVEL RELATED ILLNESS:

I. The pathogen factor is the trip itself(„real” travel illnesses )

II. On-scene hazards: the pathogen factoris the exposure at destination

III. The trip is triggering factor to the medical problem (eg. trafic accident)

IV. The preexisting disease is deteriorated or exacerbates by the trip

Peter Felkai: Travel Medicine

The The pathogen factorpathogen factor is is the travel itselfthe travel itself

Origin of the illness Triggering factor Illnessesmotion motion sickness

immobilisation deep vein thrombosis

cabin environment

hypoxia, hypercapnia,

airborne and host-to-host

infections, dehydration

psychological strain

panic disorder, real

travelling

psychosis,vegetative

neurosis

physical strain fatique; jet - lag

environmental strain

thermoregulation

problems, diarrhoea,

obstipation

psychosocial strainrage, depression, culture-

shock

travel, movement

travel related stress

The The motion sicknessmotion sickness"Some of you will get seasick," "Some of you will get seasick," "Some of you will get seasick," "Some of you will get seasick," ---- tttthe he he he captain captain captain captain admitted,admitted,admitted,admitted,---- "But as you're hanging over the rail, "But as you're hanging over the rail, "But as you're hanging over the rail, "But as you're hanging over the rail, remember that you're providing entertainment remember that you're providing entertainment remember that you're providing entertainment remember that you're providing entertainment for the rest of us.for the rest of us.for the rest of us.for the rest of us.„„„„

quoting an quoting an quoting an quoting an observation from observation from observation from observation from the ship's first the ship's first the ship's first the ship's first officerofficerofficerofficer, by sailing by sailing by sailing by sailing the Pacific in a the Pacific in a the Pacific in a the Pacific in a small shipsmall shipsmall shipsmall ship


sea-sickness

motion -sickness

space- sickness air - sickness


PREVENTION:PREVENTION:

- appropriate body position

- fresh air

- bellyful stomach (!)

- refraining of alcohol

-antivertiginose drugs

Peter Felkai MD.: Travel Medicine

The The jetjet--laglag


JetJet -- laglag

2 2 hourshours of of flyingflying = 1 = 1 time zonetime zone

laterearlier

melatonin

secretio

light - inhibits

food, cortison, body

temperature modifyes

darkness- facilitates


Prevention of jet-lag

-arteficial night environment in cabin

- argonne-diet

- melatonin preparations

- appropriate hydration

- appropriate acclimatisation time at destination

Peter Felkai: Travel Medicineswollen leg discoloured skin

TRDVT TRDVT –– traveltravel--related deep vein related deep vein thrombosisthrombosis

TheThe problem problem was was explodedexploded

In September, 2000, Emma Christofferensen, 28 years old fittness champion , died atHeathrow international airport after 20 hours flying. The cause of the death was pulmonary embolism *

* Sándor T.: Utazási thrombosis in.: Vascularis Medicina, szerk.: MeskóÉ.,Therápia Kk. Budapest, 2004, 394 – 400 pp.


* Cruickshank JM. and Gorlin R. : Air travel and thrombotic episodes: the

economy class syndrome. Lancet 1988; 2(8609):497-498.

Although the patomechanismAlthough the patomechanism, , dangersdangers

and and consequencesconsequences of of the long hault flight the long hault flight

resultedresulted DVT has DVT has been recognised for been recognised for

long timelong time , (, („„economy class syndromeeconomy class syndrome””*) *)

thethe medias medias treated the case astreated the case as a a new onenew one

and and demanded the science to do demanded the science to do

somethingsomething. . Thus the travelThus the travel--related related

medical problemsmedical problems and and the travel medicine the travel medicine

was highlightedwas highlighted..



distributiondistribution ofof compression strenghtcompression strenght ofof thethe„„flightflight”” socksock

DDecreasing ecreasing ofof

roomroom for the for the

travelerstravelers’’ leg leg in the in the

aircraft cabinaircraft cabin ( ( inin

inch )inch )

low humidity exiccosisconcentration of the hematocritand plasma is

increased

low pO2 in the aisle

relativ hypoxia

sludge -formation

long sittingvenous

congestion

the fibrinolytic activity of endothel is decreasing


DevelopmentDevelopment ofof thetheDVTDVT caused by the caused by the

too long hault sittoo long hault sit

TheThe sharp refractionsharp refraction ofof vena vena

poplitea gets the circulation slowpoplitea gets the circulation slow

andand it becames the predilectionit becames the predilection sitesite

for formingfor forming ofof sludgesludge

TRDTV TRDTV –– travel related deep vein travel related deep vein thrombosisthrombosis

-post travel embolisation, has occured in 2 weeks after travel

- travelers who never have embolisation in their medical history

- in continuous sitting position more than 5 hours or 5000 km.*

*Sándor T.: Utazási Trombozis,2008 Orv. Hetil. 2008,150,3,99-108


PreventionPrevention ofof the travel related deep vein thrombosisthe travel related deep vein thrombosis RISKRisk factors, indications

Prevention*

average traveler,

low risk

more than 5 hours immobilisation, flying

distance more than 5000 km., poor oxygene and humidity

environment in the cabine

sheduled drinking, hyperhydration,

regular stand-up and

moving, foot excercises

medium risk

as above, plus age over 40,

overweighting, varicosity,

pregnancy, ongoing substitution therapy, chronic

lung- or/and cardiac problems, contraceptives,

exiccosis

elastic/compression sock.

trombocity aggregation inhibitors (ASA, aspirin)

low molecular weight heparin (LMWH) - the last2 items have to take beforeand after flight for 2 days

high risk

as above, plus severe varicosity,

DTV in the medical history,previous lung- embolism,

existing cancerous disease,thrombophilia, operation in recent past, plaster on the lover

extremity, increased disposition to thrombosis

LMWH, full

anticoagulation

therapy ( by the helpof coumarin-

derivatives)

*Geerts et al.: Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithromboticand Thrombolytic Therapy. Chest. 2004 Sep;126(3 Suppl):338S-400S.


Triggering factor Consequence Symptoms

low cabin pressure lower PaO2, lower SaO2 dyspnoe, tachycardia

air conditioningsemi-fresh air-flow,

increased CO2

increased risk of airborne

infections, dyspnoe,

hypercapnia, fatique,

upper airway infections

rapid changes of altitude barotraumatooth ache, pain in the

body-cavities

movement of the aircraft vestibular dysfunction motion sickness

narrow sitting place, long

sitting position, immobility

disturbances in the blood-

microcirculation

DVT, increased risk of

host-to-host infections

check-in procedures,

congestion of passengerspsychosocial stress

air rage, fatique, nervous

breakdown

PERILS OF AIR TRAVELPERILS OF AIR TRAVELTravel related stress – air rage


The The pathogen factorpathogen factor is is the travel itselfthe travel itself

• Movement – related illnesses (jet – lag, DVT, motion sickness)

Illnesses resulted by travel- related stress

Travel as a stressogen factorvegetative symptoms(obstipation,diarrhoea, nausea)

mental alterations(fobia, anxiety, hyperactivity disorder, behaviourialand/or mood disorders, agression)

mental disorders(depresion, travel psychosis, culture-shock)


SourcesSources of of travel related stresstravel related stressstress source description of stress

psychological

stress

strange environment, requires a

continuous conformity and

adaptation, timing difficulties

physical stress

uncommonly much walking, ill-

prepared body, insufficient quality

and amount of sleeping

environmental-

related stress

unusual climate, unusual structure of

food, etc.

pszichosocial

stress

human relations of the travel group,

depression of the expatriots,

uncontrolled sexual life, cultureshock

psychosocial stress

- fear of flying ( 24,4%*)

- withdraval of nicotine,

alcohol or drug

- mistrust in the pilot, in cabine-crew

- bothering at the security check

- long cue, frustration * McIntosh IB. et al.:Prevalence, Intensity, and Sex Differences in Travel Related Stressors.

J . Travel Med. 1996 Jun 1;3(2):96-102.

NAKED AIR® -the next step to the airport security

lost in a strangecountry, don’t speak the language,unfamiliar society,obscure traditions...

too much walking

Psychiatric problems abroad are responsible for 15 -20% of the patient

repatriation


Thank you for your attention !

Peter Felkai: Travel medicine

The motion sickness Some of you will get...

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