Bulletin #5 – Medical

February 3rd, 2015
Important Medical Info for the Tour
Before You Go

Make sure you are fit and well. Get the following check-ups: medical, dental, and ophthalmologic. As you are embarking on a long trip, make sure your teeth are fine, and not in need of major dental work. If you wear glasses or contact lenses, take a spare pair and your written prescription. If you take prescription medication, ensure you bring an adequate supply (see Medical Packing list below). For your safety, take time before the trip to educate yourself on each of the countries we are passing through. Ask the advice of friends and family who have travelled to these places before. Read travel guides and other travel literature. Stay up to date on the constantly changing political scene in the countries encompassed on the tour. Our tour medic will also be available for email inquiries if you have specific medical questions that come to mind.

Immunizations

It is of the utmost importance to protect yourself against preventable diseases. Leave plenty of time to get your vaccinations, as some of them require an initial shot followed by a booster. We recommend that you visit your local medical travel clinic at least two months before your departure, in order to receive the appropriate vaccinations, and obtain the most up-to-date information on the countries we will be traveling through.

Malaria Tablets

Malaria is a potentially fatal disease transmitted by mosquitoes.  It is important to realise that we are at times travelling through areas with malaria and it is strongly advised to take malaria tablets for the prevention of malaria.  Talk to your travel doctor about which portions of the trip to take the tablets and which medication is right for you as some of the medications do come with side affects (sensitivity to sun, depression, and in some cases hallucinations, or wild dreams).

Remember that malaria tablets do not give you 100% protection against malaria.  It is also important to avoid getting bitten – this means using insect repellent, long sleeves and pants, and zipping your tent up tight at night time as it also doubles as your mosquito net.  Malaria tablets greatly reduce the risk of contracting malaria, and also will mean that if you do get malaria it won’t be as severe as if you weren’t taking the tablets – they are still definitely worth taking!

Suggested Medical Packing List

Please remember that these are some suggestions, but we are not trained medical professionals. We recommend you take this list and discuss this with your travel doctor before you go. They may have other suggestions – follow their advice and do not take any medications that you do not understand their use or dosages. Always keep all medications in their original packaging as you may be questioned by customs or local authorities particularly at airports and it is helpful if you need advice from the tour medic. Please remember that our tour medic cannot prescribe any medication and is only able to make suggestions based on the medications and advice you have received from your doctor.

  • Your usual prescription medication (enough supply to last the tour)
  • Antimalaria medication
  • Basic Anti-diarrheal
  • Antibiotic  for travellers diarrhoea
  • Topical antibiotic cream for wound infections/abscesses
  • Antibiotic for wound infection
  • Anti inflammatory
  • Simple painkillers
  • Stronger prescription painkiller
  • Throat lozenges
  • Anti-spasmodic
  • Oral rehydration salts
  • Antacid
  • Antiemetic (for nausea/vomiting)
  • Assorted sizes of bandaids and dressings
  • Bandages – gauze and compression
  • Sports tape
  • Nu skin/moleskin dressings
  • Sterile gauze
  • Sunscreen (min SPF 30)
  • Lip balm (min SPF 30)
  • Zinc cream (this is great for both sun protection and saddle sores)
  • Moisturising cream e.g. sorbolene cream
  • Wound cleanser and antiseptic  (e.g. iodine solution, betadine)
  • Sunburn treatment cream
  • Insect repellent
  • Hand sanitizer
  • Baby wipes (for personal cleaning when showers not available)
  • Small mirror (to help inspect saddle sores)

Suggestions for first aid kit for your bike (carry in small Ziploc baggie):

  • Band aids, dressings, sterile gauze, tape
  • Sunscreen (min SPF30)
  • Lipbalm (min SPF 30)
  • Anti-inflammatory/pain med
  • Rehydration salts
  • Hand sanitizer
Handlebar Palsy

Handlebar palsy (or ulnar nerve neuropathy) is another problem commonly encountered on tour. This is when the ulnar nerve in the palm of your hand becomes irritated and inflamed due to the excessive amounts of road vibration and pressure on them while cycling.  Symptoms include “pins and needles” in the pinkie and ring finger, decreased movement in the fingers, and in some cases severe pain.  This is usually as a result of any one (or a combination) of poor bike setup, poor riding technique or some people are just more prone to develop this problem than others.  A good tip in preventing this is for flat bar riders to use ergonomically shaped handlebar grips and bar ends, cyclocross riders can double tape their handlebars to decrease the road vibrations.  Wear well padded cycling gloves and take a second pair as these will wear out after time.  Nerves take a long time to heal and it can take weeks to months for symptoms to resolve, and if untreated will risk leaving a permanent loss of strength and movement to the fingers.

Tour Medical Support

The tour medic(s) are available on the tour in the event of illness or injury. They are trained medical professionals – often a nurse, doctor, or paramedic by training. Medical care will be provided 24/7 for emergency situations and the tour medic will also run a clinic at a set time each afternoon (rest days not included). It is useful for the tour medic if you save your problems until during clinic hours when they have the tools, resources and time to make a proper assessment.

The tour provides a reserve of medical supplies and equipment to assist riders who fall ill or suffer from injury but please note that these supplies are limited and are not intended for everyday use. It is an expectation that you come well stocked with medical supplies – please refer to the above section on Suggested Medical Packing List and discuss this with your doctor). If you need to use medications or supplies from our stock, you will be expected to pay for these. As stated earlier our tour medic cannot prescribe any medication and is only able to make suggestions based on the medications and advice you have received from your doctor.

Gastrointestinal illness/Dehydration

Gastrointestinal illness and dehydration tends to be the number one concern for cyclists on the Tour.   An adequately hydrated body should have the urge to pass urine every 3-4 hours.  We will experience high temperatures with lots of humidity, making the battle to keep hydrated a challenge even for a healthy body.  You will need to ensure you drink plenty of fluids (may require 6-1oL each day).  Remember to rehydrate at the end of each day so that you don’t start the following one already dehydrated.  Monitor your urine output – on hot days during the tour passing urine 4 times a day (as an absolute minimum) is a realistic enough goal!

Gastrointestinal illness (diarrheoa sometimes accompanied with vomiting) tends to affect approximately 80% of cyclists at some stage while on the tour.  Riding 124km on average per day is going to make your body fatigued and suppress its immune system which makes it more likely for it to be unable to fight off the bugs (bacteria) it usually would be able to handle.  Sanitation in parts of South America is of a different standard than it is at home so there are more of these bugs around.  These bugs are usually spread by contact (i.e. touching a contaminated surface, then eating with bacteria still on the hands).   Your best bet in preventing  getting sick to practice good hand hygiene – wash your hands often, especially before eating, assume every surface you touch is a contaminated surface, carry hand sanitizer with you at all times (in case you find a good coke stop).

The number one treatment for diarrhoea is rest.  Given adequate rest, most diarrhoea should go away on its own.   Come and talk to the medical staff before commencing yourself on antibiotics and antidiarrheal medication as the treatment for diarrhoea is not completely straight forward.

Heat & Sun

Along with dehydration, preventing heat exhaustion and sunstroke are primary concerns on the Tour as part of the Expedition occurs in very hot locales, with little shade available. You will need to take extra precautions to guard against skin damage and heat-related illness. While in the sun, wear light-coloured, lightweight, heat-reflective clothing, gloves and helmet. Use a sunscreen with a minimum SPF of 30 that protects from both UVA and UVB rays, and reapply several times a day, remembering to cover ears and back of neck. Lip balm with SPF 30 or higher is also highly essential or zinc cream if you are already prone to sun sensitivity.  Your eyes are also sun-sensitive, and should be protected from UVA and UVB rays with good-quality sunglasses.

You must be extra careful about sun exposure if you are taking medication. Many common over-the-counter and prescription drugs such as antihistamines, antibiotics and oral contraceptives may increase your risk of photo sensitivity, and therefore sunburn. Consult with your doctor or pharmacist to see if there are precautions you should follow.

Heat exhaustion occurs when people exert themselves in a hot, humid environment, and lose excessive amounts of body fluids and electrolytes through sweating. If these fluids are not replaced adequately, the body can overheat and have circulation disturbances, similar to a mild form of shock. If not treated, this may progress to heat stroke, or extreme hyperthermia, where the body’s temperature may be 40 C (105 F) or more. Symptoms include confusion, dizziness, flushed hot/dry skin, difficulty breathing and an absence of perspiration. Heat stroke may be fatal and requires immediate intervention. Look out for each other – if you suspect one of your fellow riders is developing heat exhaustion/heat stroke find some shade, sit down, encourage oral hydration if the person is alert enough to drink.

Saddle Sores

Almost everyone on the tour suffers from some degree of ‘bike bum’  somewhere in the trip. This could be anything from minor chafing to full-on painful skin breakdown, or  even abscesses, requiring dressings, medication, and at worst, riding the truck instead of your bike!

The term ‘saddle sores’ refers to areas of tenderness/skin breakdown due to prolonged or repeated pressure on one area over time. With cycling, this happens primarily on the ‘sit bones’, usually appearing on both buttocks simultaneously as tender, flat, reddened areas, which if not treated can degrade to the point of open, inflamed tissue.

Prevention is the best treatment for saddle sores. First off, even before you leave home, follow TdA’s suggested training schedule so that your body and your butt are used to long days in the saddle. Check out your seat height; if you are rocking from side to side, creating friction, you can chafe in less than an hour! Invest in five pairs of riding shorts with a high-quality chamois; wearing a clean pair of shorts every day will cut down on dirt and bacteria accumulation, as well, changing up where seams rest will avoid chafing in one spot day after day. Most importantly, use an anti-chafing/chamois cream every day, applying liberally to yourself (i.e. the ‘sit bones’), the chamois and any areas of chafe or pressure. Re apply at lunchtime!  Chamois creams can usually be purchased at your local bike/running store.  You can apply a zinc based cream at night time (nappy cream works just fine!). Equally as important is ensuring to wash/wipe yourself off at the end of your riding day; keeping yourself clean and dry will help to prevent skin breakdown and promote healing of early pressure sores.

It’s not necessary to wear underwear underneath your cycling shorts, the seams will only exacerbate the problem!  If you are having problems experiment wearing two pairs of cycling shorts simultaneously – a little extra padding goes a long way!

Some riders also experience painful boils in the groin and/or buttock areas; these differ from pressure sores in that they are raised, may be reddened and hard, are painful to touch, and may have pus discharge. They usually do not occur simultaneously on both ‘sit bone’ areas like saddle sores do. Boils can usually be treated with several days of an antibiotic cream application, but severely inflamed or large boils may require oral antibiotics and possibly incision and drainage.

Remember your tour medical staff are medical professionals, they have seen it all before and it is a much better to get your saddle sores sorted early.  It’s not necessary to feel embarrassed.

Safety

Your safety on this tour is of the utmost concern to us. As with all travel to unfamiliar territory, please respect the local culture and it’s people, and observe the local laws. Your greatest hazard is the motorized vehicle, so practice defensive riding!  Some roads we travel on will be better than others – there are times when you will be asked to ride in single file and times where it will be safe to ride two abreast.  Please listen and adhere to this advice.

Dogs

Dogs like chasing people on bicycles.  If you get chased by a dog the best thing to do is to get off your bike, keep your bike between you and the dog, and walk away slowly.  Usually the dog will become much less interested once you get off your bike.  Please talk to your doctor about Rabies vaccinations before you leave.

Insect Precautions

Careful precautions can significantly reduce the risk of insect-borne diseases such Malaria, tick-borne encephalitis, and many other viral and parasitic diseases. Mosquitoes, ticks, sand flies, black flies, and spiders can all cause not only painful bites or skin sores, but they may also cause serious illness. At dusk, and other times when insects are biting, cover up as much as possible. Wear long-sleeved shirts, pants, and socks at night. Use an insect repellent containing DEET on exposed skin and on clothing. Spray your tent and/or sleeping area with insect repellent, or use a permethrin-impregnated netting. Try to avoid areas of stagnant water where mosquitoes breed, and also beware of brushy areas where ticks may live.

The danger of contracting insect-borne diseases will heighten in particular areas of the tour; you will be given additional warnings during this time to take appropriate precautions.

Food and Nutrition

Good nutrition is an important element in staying healthy, especially when performing strenuous activities such as the Tour. We will be providing you with cooked meals prepared on site, using as many local ingredients and vegetables as are available. We provide a generous amount of food at breakfast, lunch, after your ride and at dinner but the food supply is not endless. At times the amount of food available may be limited and we will make sure that it is shared equally amongst the riders. Individual needs will vary and some riders may need to supplement the amount of food they consume. We will also provide you with treated water for drinking purposes. You may also want to bring along multivitamins to make sure you are covered. On rest days you will have the opportunity to partake in local cuisine, or in major cities maybe even find some of your favourite foods!

Taking care with what you eat and drink is the most important health rule while on tour. When eating the local fare, here are some suggestions:

  • Follow the old adage, which says, “If you can’t cook it, boil it, or peel it…forget it!”
  • Always choose food that has been freshly and thoroughly cooked, and is served hot. Undercooked meat, particularly mince, should be avoided.
  • Avoid buffet food, or anything that has been re-heated or left exposed to flies.
  • Avoid seafood. Shellfish, such as mussels, clams, and oysters should also be avoided. Steaming does not make shellfish safe for eating.
  • Raw fruit and vegetables should be carefully and thoroughly washed with clean, purified water; ideally they should be easy to cut open or peeled without contaminating the flesh. Fruits like bananas and papayas are the safest.
  • Ice cream is usually OK if it is a reputable brand name, but beware of products bought from street vendors, and ice cream that has been thawed and refrozen.
  • If a place looks clean and well run, then food is probably safe. Places packed with locals and/or travelers usually indicate a reputation for good food and hygienic practices, whereas these may be questionable in empty restaurants.
Water and Drinks

Throughout the tour we will provide you with clean water for drinking. However, on your rest days or at local venues, keep in mind the number one rule of thumb: When in doubt, don’t drink the water; and this includes ice.

Use only water from bottles with an intact seal, not tops or corks. Have bottled water opened in your presence, as some may have been refilled with tap water. Take care with fruit juices, as water may have been added. Tea and coffee should be fine, as the water has been boiled.

Milk should be treated with suspicion, as it is often not pasteurized. Boiled milk and yogurt should be fine as long as they have been kept covered and refrigerated.

Hygiene

The tour is a traveling community, and as such, we need to be acutely aware of our hygiene practices and how they affect our fellow cyclists as well as the locals we come into contact with. This cannot be stressed enough: hand washing, hand washing, hand washing!! Proper and frequent hand washing is the best way to avoid illness and prevent disease transmission.

General Discomfort, and Keeping Positive!

The tour is challenging in more ways than one. Physically, your body will have to endure a multitude of insults over the course of nearly 6 months. Prepare it beforehand by following TDA’s recommended training schedule. Try to stretch after a riding day to decrease muscle pain and stiffness. Bring medications and supplies as suggested above, and don’t be stubborn; seek medical advice as necessary on the tour. And most importantly, bring along a good mental attitude; a healthy, positive outlook is the best thing to have to get you through this adventure!

When you Get Home

Many travelers stop taking anti-malarial drugs as soon as they get home or immediately after leaving a malaria zone. This practice is dangerous and may result in the traveller acquiring malaria anyway, as the medication should be taken for the prescribed period of time afterwards in order to kill any of the parasites that may still be in the body. Malaria may develop months after the exposure, so it is important to take the full course of medications, and also notify your physician where you have been traveling if you become ill.

Once home, remember that your body has been through a lot of changes over the course of the Tour! In the same way that you may have had stomach upset at the beginning of the trip due to new foods, your system may need time to adjust to getting back to your normal diet; take it easy and don’t overdo it with your favourite foods.  Some people also experience mild depression, and find it hard to get back to ‘reality’; this is normal after the adventure you’ve just been on! Sharing your stories with friends and family, and keeping in touch with your new friends from the Tour can help ease your transition back into your routine.

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