I recently received this question from a reader: “What is a travel medicine specialist, and why should I see one?”
A visit to a travel medicine specialist (also known as a travel doctor) is a critical step of trip preparation—not only for elderly travelers, but for anyone planning a trip to a less-developed part of the world, where certain diseases not typically found in the USA are prevalent (and your associated tolerance is nonexistent).
I remember my first visit to a travel doctor as if it were yesterday . . .
I was in the beginning stages of my career with Alison Engine Company, a General Motors division (later sold to Rolls-Royce) in Indianapolis that manufactured helicopter and regional aircraft engines. When my company asked me attend the world-famous Singapore Airshow as one of its marketing reps, I was flying as high as the EMB-145 aircraft that housed our engines!
Company policy required all of Alison’s airshow attendees to visit a travel medicine specialist before traveling. That’s when I learned about travel doctors—and about the important work they do. I now make an annual visit to my own travel doctor, who keeps me healthy regardless of where I’m off to next.
In order to provide a full answer to my reader’s question, I interviewed Douglas Zeiger, who’s been my travel doctor for over 4 years. A board-certified specialist in infectious diseases and internal medicine, Dr. Zeiger serves on the faculty of New York University School of Medicine and is an attending physician at NYU Medical Center. He has specialized in travel medicine since July of 1988 and has plenty of helpful information on the subject.
Val Grubb (VG): What are the benefits of seeing a travel doctor before going out of the country (regardless of whether a person is over 65)?
Douglas Zeiger (DZ): The main reason to see a travel doctor is to prevent everything that is preventable when it comes to your health in another country. Depending on where you go, you may have a much greater chance of getting sick there than at home. In some places your chances of getting sick are tremendously high, but in others you may have only a mild increase over your risks at home.
Obviously, most people who visit a travel doctor are less likely to get sick from diseases for which they get vaccinated. But they’re also less likely to get sick from illnesses that come from insects and infected food and water—such as traveler’s diarrhea—because they’re more clued in to what they must do to prevent them.
A travel doctor will provide recommendations on locations based on a traveler’s particular health situation. Someone with asthma, for example, might not want to visit Beijing, which has notoriously poor air quality. Similarly, a pregnant woman might want to pass on locations with poor sanitation or inadequate medical facilities.
VG: What does a travel doctor offer that a regular primary care physician (PCP) does not?
DZ: A PCP and a travel doctor serve two very different purposes for the traveler.
Most primary care doctors don’t really have much knowledge about what is required in specific regions outside the United States. Therefore, it would be unwise to assume that your primary doctor has any expertise in this area.
A travel doctor, on the other hand, can tell you what factors in another country may affect your existing medical conditions, can explain how to avoid becoming sick, and can provide medicines if you do pick up an illness abroad. The typical primary care physician is not well versed in these areas.
But you should still see your PCP prior to going out of country, because he or she may have suggestions based on your overall physical health that may affect the location or duration of your travels or the activities you undertake there. When traveling with an aging parent, it’s an especially good idea to get a doctor’s signoff that your parent is physically capable of making the trip and to identify any medical issues you (as your parent’s travel companion) should be on the lookout for.
VG: Do you recommend visiting a travel doctor even if you’re going to someplace like Paris or London?
DZ: Not necessarily. Even though the risks with such travel are a little greater than staying home, they are not that much higher.
One caveat is that travel doctors specialize in vaccinations, many of which you should have whether or not you’re leaving the country. A PCP is familiar with childhood vaccination recommendations but doesn’t always think of vaccines for adults. For example, a travel doctor would know that anyone living in the USA should get vaccines for tetanus, pneumonia, and shingles, but a PCP might not be aware of that recommendation.
Another example: in the USA the pneumococcal vaccine (which protects against pneumonia, among other illnesses) is recommended for all people age 65 and over. Anyone with diabetes or asthma, however, should get the vaccine sooner—a recommendation that many PCPs don’t know. A travel doctor, on the other hand, would be on top of this because of his or her deep knowledge of vaccines.
Seeing a travel doctor makes you much more likely to get the vaccines you need even if you never leave the country.
VG: What factors make it imperative to see a travel doctor before traveling out of country?
DZ: Things happen to people when they are traveling. The risk of infection increases with age, so that is a major driver. Your immune system isn’t as robust. Your age, how sick you are, and where you’re going can all increase your chance of getting sick.
Getting sick while traveling happens at a slightly higher frequency than when you’re at home, because you’re under more stress when you travel—even when you’re taking a trip for fun. Change is more difficult to handle with age, and when an older person is away from familiar surroundings he or she can experience more stress. So it’s very important for an elderly person (or someone who is sick) to see a travel doctor before going out of country.
VG: When travelers visit a travel medicine specialist, what information should they bring and what questions should they be prepared to answer?
DZ: You should be ready to discuss your medical history, including any medications (and dosages) you’re currently taking. You should also mention diseases you’ve had, such as respiratory illnesses (which are of particular concern in certain countries with poor air quality, such as China). The doctor also needs to know about your drug allergies, because those may affect the vaccines administered.
If you’re going to a big country such as China or Brazil, it’s also critical to tell the travel doctor what parts of those countries you’ll be visiting. In fact, bringing a map with you that shows the region you’ll be touring is most helpful. The CDC [Centers for Disease Control and Prevention] website and many other websites use maps to show rates and ranges, so if you’re visiting a remote site in a large country, having the location pinpointed on a map will ensure that the travel doctor has the most accurate information—and that you get the vaccines you need.
VG: Is there anything travelers should ask a travel doctor?
DZ: Most travel doctors should address all of your concerns as part of the routine exam and questions. If it doesn’t come up during the visit, though, you may want to ask if you need to make any changes to any regular prescription medications you’re taking with you.
In my interview with Dr. Zeiger, he provided a lot of useful advice for travelers—so much, in fact, that I couldn’t fit it all into one blog post! So tune in on Thursday for the rest of my interview with him, when we discuss some of the specific vaccination issues travelers might encounter as they prepare to go abroad, as well as some of the details of finding a travel doctor and dealing with health insurance claims.