Microsoft word - appendix 6 health issues f10-2.doc

Preparing for Your Trip to Mexico
Before visiting Mexico, you may need to get the following vaccinations and medications for vaccine-preventable diseases and other diseases you might be at risk for at your destination: (Note: Your doctor or health-care provider will determine what you will need, depending on factors such as your health and immunization history, areas of the country you will be visiting, and planned activities.) To have the most benefit, see a health-care provider at least 4–6 weeks before your trip to allow time for your vaccines to take effect and to start taking medicine to prevent malaria, if you need it. Even if you have less than 4 weeks before you leave, you should still see a health-care provider for needed vaccines, anti-malaria drugs and other medications and information about how to protect yourself from illness and injury while traveling. Be sure your routine vaccinations are up-to-date. Routine vaccines, as they are often called, such as for influenza, chickenpox (or varicella), polio, measles/mumps/rubella (MMR), and diphtheria/pertussis/tetanus (DPT) are given at all stages of life; see the childhood and adolescent immunization schedule and routine adult immunization schedule. Summary of recommendations:
Vaccinations: Recommended for all unvaccinated people traveling to or working in countries with an intermediate or high level of hepatitis A virus Hepatitis A
infection where exposure might occur through food or water. Cases of travel-related hepatitis A can also occur in travelers to developing countries with "standard" tourist itineraries, accommodations, and food consumption behaviors. Recommended for all unvaccinated people traveling to or working in Mexico and Central America, especially if staying with friends or relatives or visiting smaller cities, villages, or rural areas where exposure might occur through food or water. Hepatitis B
Recommended for all unvaccinated persons traveling to or working in countries with intermediate to high levels of endemic HBV transmission (see map), especially those who might be exposed to blood or body fluids, have sexual contact with the local population, or be exposed through medical treatment (e.g., for an accident). For travelers who may have direct contact with animals and may not have access to medical care. Routine immunizations
Recommended if you are not up-to-date with routine shots such as, measles/mumps/rubella (MMR) vaccine, diphtheria/pertussis/tetanus (DPT) vaccine, poliovirus vaccine, etc. APPENDIX VI - HEALTH ISSUES - 2 HEALTH CONSIDERATIONS SPECIFIC TO THE YUCATAN
The Centers for Disease Control and Prevention provides this information to travelers to Mexico: Limited to areas infrequently visited by travelers, including small foci along the Guatemala and Belize borders in the state of Quintana Roo and small foci along the Guatemala border in the states of Chiapas and Tabasco; rural areas in the states of Nayarit, Oaxaca, and Sinaloa; and in an area between 24°N and 28°N latitude, and 106°W and 110°W longitude, which lies in parts of Sonora, Chihuahua, and Durango. No malaria along the United States-Mexico border and in the major resorts along the Pacific and Gulf coasts. If you will be visiting an area of Mexico with malaria, you will need to discuss with your doctor the best ways for you to avoid getting sick with malaria. Ways to prevent malaria include the following: Taking a prescription antimalarial drug Using insect repellent and wearing long pants and sleeves to prevent mosquito bites Sleeping in air-conditioned or well-screened rooms or using bednets Primaquine is the preferred antimalarial drug (only after G6PD testing) in Mexico. Atovaquone/proguanil,
chloroquine, doxycycline, and mefloquine are alternative choices. For information that can help you and your doctor
decide which of these drugs would be best for you, please see
Malaria Contact for Health-Care Providers:
For assistance with the diagnosis or management of suspected cases of malaria, call the CDC Malaria Hotline: 770-488-7788 (M-F, 9 am-5 pm, Eastern time). For emergency consultation after hours, call 770-488-7100 and ask to speak with a CDC Malaria Branch clinician. You should purchase your antimalarial drugs before travel. Drugs purchased overseas may not be manufactured according to United States standards and may not be effective. They also may be dangerous, contain counterfeit medications or contaminants, or be combinations of drugs that are not safe to use. Halofantrine (marketed as Halfan) is widely used overseas to treat malaria. CDC recommends that you do NOT use halofantrine because of serious heart-related side effects, including deaths. You should avoid using antimalarial drugs that are not recommended unless you have been diagnosed with life-threatening malaria and no other options are immediately available. Malaria is always a serious disease and may be a deadly illness. Humans get malaria from the bite of a mosquito infected with the parasite. Prevent this serious disease by seeing your health-care provider for a prescription antimalarial drug and by protecting yourself against mosquito bites (see Prevent Insect Bites). Malaria symptoms may include:
nausea and vomiting Malaria symptoms will occur at least 7 to 9 days after being bitten by an infected mosquito. Fever in the first week of travel in a malaria-risk area is unlikely to be malaria; however, you should see a doctor right away if you develop a fever during your trip. Malaria may cause anemia and jaundice. Malaria infections with Plasmodium falciparum, if not promptly treated, may cause kidney failure, coma, and death. Despite using the protective measures outlined above, travelers may still develop malaria up to a year after returning from a malarious area. You should see a doctor immediately if you develop a fever anytime during the year following your return and tell the physician of your travel. APPENDIX VI - HEALTH ISSUES - 3 DENGUE FEVER
Local news reports show dengue and hemorrhagic dengue cases are on the rise in the states of Yucatan, Quintana
Roo and Campeche. (source U.S. Consular in Merida)
Dengue is spread by mosquitoes. To reduce the risk of contracting dengue, the U.S. Center for Disease Control
(CDC) recommends wearing clothing that exposes as little skin as possible and applying a repellent containing
DEET, picaridin, oil of lemon eucalyptus or IR3535 as the active ingredient.
For further information on dengue fever, please visit the Centers for Disease Control and Prevention's (CDC) web
site at
Other helpful links include:

What is Dengue Fever?
Dengue fever is a flu-like illness caused by being bitten by an infected mosquito.
Symptoms of Dengue:
The symptoms of dengue may appear from any time between three days and two weeks from being infected. If you
become ill after returning from a trip, be sure to tell your doctor where you were traveling.
Sudden onset of fever Severe headache, muscle and joint pain Gastrointestinal problems
Dengue Fever Treatment:
Dengue fever is treated with rest, and acetaminophen to bring down the fever. It is recommended to take in plenty of
fluids to avoid dehydration. Usually symptoms clear up in about two weeks but some people may feel tired and
sluggish for several weeks.
Watch for warning signs as temperature declines 3 to 7 days after symptoms began. Go IMMEDIATELY to an
emergency room or the closest health care provider if any of the following warning signs appear:
Severe abdominal pain or persistent vomiting Red spots or patches on the skin Bleeding from nose or gums Black, tarry stools (feces, excrement) Drowsiness or irritability Difficulty breathing
How to Avoid Dengue Fever:
There is no vaccine against dengue fever. The illness is avoided by taking preventive measures:
wear clothing that covers your skin use an insect repellent containing DEET stay in areas with air-conditioning and/or screens and mosquito nets
Dengue Hemorrhagic Fever:
Hemorrhagic Fever is a complication of dengue. Persons who have been infected with one or more forms of dengue
virus are at greater risk for this more severe form of the disease.

Many diseases, like malaria and dengue, are spread through insect bites. One of the best protections is to prevent insect bites by: Using insect repellent (bug spray) with 30%-50% DEET. Picaridin, available in 7% and 15% concentrations, needs more frequent application. There is less information available on how effective picaridin is at protecting against all of the types of mosquitoes that transmit malaria. Wearing long-sleeved shirts, long pants, and a hat outdoors. Remaining indoors in a screened or air-conditioned area during the peak biting period for malaria (dusk and dawn). Sleeping in beds covered by nets treated with permethrin, if not sleeping in an air-conditioned or well-screened room. Spraying rooms with products effective against flying insects, such as those containing pyrethroid. Vaccine is recommended for any traveler born after 1956 who does not have either a history of two documented
measles immunizations or a blood test showing immunity. A measles outbreak was reported from Distrito Federal,
Estado de Mexico, and Hidalgo in early 2004. Many adults who had only one vaccination show immunity when
tested and do not need the second vaccination. Those born before 1957 are presumed to be immune to measles.
Measles vaccine should not be given to pregnant or severely immunocompromised individuals.

Hepatitis A
vaccine is recommended for all travelers over one year of age. It should be given at least two weeks
(preferably four weeks or more) before departure. A booster should be given 6-12 months later to confer long-term
immunity. Two vaccines are currently available in the United States: VAQTA (Merck and Co., Inc.) and Havrix
(GlaxoSmithKline). Both are well-tolerated. Side-effects, which are generally mild, may include soreness at the
injection site, headache, and malaise.

vaccine is recommended for all travelers. It is generally given in an oral form (Vivotif Berna) consisting of
four capsules taken on alternate days until completed. The capsules should be kept refrigerated and taken with cool
liquid. Side-effects are uncommon and may include abdominal discomfort, nausea, rash or hives. The alternative is
an injectable polysaccharide vaccine (Typhim Vi; Aventis Pasteur Inc.), given as a single dose. Adverse reactions,
which are uncommon, may include discomfort at the injection site, fever and headache. The oral vaccine is approved
for travelers at least six years old, whereas the injectable vaccine is approved for those over age two. There is no
data concerning the safety of typhoid vaccine during pregnancy. The injectable vaccine (Typhim Vi) is probably
preferable to the oral vaccine in pregnant and immunocompromised travelers.

Hepatitis B
vaccine is recommended for travelers who will have intimate contact with local residents or potentially
need blood transfusions or injections while abroad, especially if visiting for more than six months. It is also
recommended for all health care personnel. Two vaccines are currently licensed in the United States: Recombivax
HB (Merck and Co., Inc.) and Engerix-B (GlaxoSmithKline). A full series consists of three intramuscular doses
given at 0, 1 and 6 months. Engerix-B is also approved for administration at 0, 1, 2, and 12 months, which may be
appropriate for travelers departing in less than 6 months. Side-effects are generally mild and may include discomfort
at the injection site and low-grade fever. Severe allergic reactions (anaphylaxis) occur rarely.
All travelers should be up-to-date on routine immunizations, including
Tetanus-diphtheria vaccine (recommended for all travelers who have not received a tetanus-diphtheria
immunization within the last 10 years.)
Varicella (chickenpox) vaccine (recommended for any international traveler over one year of age who
does not have either a history of documented chickenpox or a blood test showing immunity. Many people
who believe they never had chickenpox show immunity when tested and do not need the vaccine. Varicella
vaccine should not be given to pregnant or immunocompromised individuals.)

Food and Water

The greatest threat while traveling in Mexico is the water. The Mexican government now advises its own citizens to
boil their water before drinking it. If you don't want to be the victim of the irrepressible diarrhea known to Mexicans
as turista, be careful of what you put into your body: DO NOT DRINK THE WATER!!!! You can buy mineral
water or purified water that is suitable for drinking. Do not brush your teeth or even rinse your toothbrush in running
tap water. Do not eat uncooked vegetables, including lettuce, in any but the most immaculate restaurants. If or when
you buy fruits or vegetables make sure that the skin is unbroken, and peel them yourself. Wash your hands in
purified water before you handle food. Watch out for market or street vendor food, which may be washed in dirty
water. It is also wise to exercise caution when eating on the street because many of these vendors do not have
access to handwashing facilities, which further contaminates food and increases the risk of contracting bacteria to
which your immune system is defenseless. If you choose to eat off the street you also run the risk of contracting
Hepatitis A from vendors who do not wash their hands. The only exception to this rule is if you are eating out with
your host family. They generally know which vendors exercise sanitary practices, and which do not. Otherwise, do
not take the risk. Peel all fruits and vegetables before you eat them. Packaged ice cream is usually safe if it is
bought from the grocery store, but do not buy homemade ice cream off the street unless your family says that it is
safe. Meat, poultry, eggs, and fish should be cooked thoroughly and should be eaten while still hot because bacteria
thrive at room temperature on moist, cooked foods and can become unsafe within a few hours. NOTE: Clams,
oysters, and shellfish are a common source of hepatitis, while raw meat and fish contain worms. Exercise caution
when eating these items. In other words, it is highly unwise to eat raw meat. Also, avoid eating crab meat. The CDC
has reported many cases of cholera associated with the ingestion of this food in Latin American countries.
When eating spicy-hot food, be sure to eat bread, rice, and/or beans to relieve the burning sensation rather than drink
water. Mexicans themselves usually use a pinch of salt. Carbonated drinks also help. Hot, spicy food is called
picante or picoso, not caliente, which only refers to the temperature of the food. Be careful: don't go overboard on
foods that you aren't used to eating when you first get to Mexico; your body needs time to adjust to new eating
habits. Over time your body will adapt and you will be able to be a little more adventurous with the foods that you
eat without getting sick. But, for the first few days, be attentive to what you eat and where you eat and how much
you eat.
Also beware of ice, juices, or frozen treats that may have been prepared with bad water. Remember that ice is no
safer than the water that it was made from. If local water is unsafe, then ice will be too. Adding alcoholic beverages
will in no way "purify" the contaminated ice. Make sure to dry the perspiration on the outside of coke bottles, soda
cans, or drinking glasses because even this minute amount of water can be teeming with bacteria and can cause
undesirable gastrointestinal problems such as diarrhea. Be sure to buy bottled water, boil tap water (for at least 7-8
minutes), or drink bottled liquids. Although water purification tablets, chemical purifiers (such as iodine), and
portable water filters are available at your local pharmacies and sporting goods stores, the Center for Disease
Control (CDC) does not recommend or guarantee the safety of these products in purifying your water. In high-class
restaurants or hotels you'll get agua purificada; elsewhere it may not be on hand, and may be untrustworthy if it is.
A golden rule in Mexico is: boil it, peel it, cook it, or forget it! Below you will find some general information on
how to manage gastrointestinal problems in Mexico.

Symptoms include:
Increase in the number of your bowel movements. A change in the consistency of bowel movements (watery stools).
How to prevent:

Wash your hands, wash your hands, and wash your hands! Especially before eating and after using the restroom. Also after touching any animals. Do not eat food off the street. Try not to eat too much between meals (since snacking usually requires buying food outside the family's home or being tempted to eat off the street). Drink only purified water that is bottled or boiled. Do not buy popsicles (paletas) or frozen treats (raspadas) of the street. Only buy them from sanitary establishments. APPENDIX VI - HEALTH ISSUES - 6 Suggested diet to follow if you experience diarrhea:
Remember the BRAT diet: bread/bananas, rice, apples, and toast. Papaya, te de manzanilla (chamomile tea), caldo de pollo (chicken soup), and soda are also helpful. Other foods that you can eat include: sopa de verdura (vegetable soup), guayaba (fruit), and peras (pears). Drink plenty of liquids like water, apple juice, pedialyte (for children is a great liquid to replace the electrolytes that are lost during episodes of diarrhea), and sopa aguada. Avoid the following foods: greasy foods, chiles, pork, seafood, alcohol, and mangoes.
Available treatments include:

With a fever: Two tablets of Bactrim F per day every twelve hours for seven days. Available over the counter at the local pharmacy (farmacia). Bactrim F is only primarily used with respiratory infections, but can also be used with gastrointestinal infections. Caveat: Bactrim will make you extremely sensitive to the sun. Be sure to protect yourself accordingly and wear sunscreen with an SPF of 15 or greater to avoid a severe sunburn! Without a fever: One tablespoon of Kaopectate (Caolin y Pectina) every six hours for three days. This is also available over the counter at pharmacies in Morelia. Yogurt is also a good treatment to replace the normal flora (bacteria) that resides in your intestines. Lactipan will accomplish the same objective and is considered one of the best treatment options for replacement of essential bacteria. This is available over the counter at the pharmacies in Morelia. If you are going to be away from the bathroom for an extended period of time: Imodium AD is an option. However, this is not a solution to your problem. It merely masks the symptoms that you are experiencing temporarily. Imodium is also dangerous because it can cause a serious condition called paralytic ileus in which your intestines stop functioning and are unable to dispose of your body's waste. This causes toxins to back up into your body and can spread infection to other parts of your body, including your bloodstream. This can be fatal if not addressed by a medical professional. Do not abuse antidiarrheals such as Imodium AD. Do not use them for more than 2-3 days. Whatever you do don't take Lomotil, which is a widely prescribed antidiarrheal. As mentioned before, antidiarrheals are virtually ineffective because they do not wash out the bacteria, they merely paralyze your intestines, and the diarrhea will most likely recur. Another drug that should be avoided in the treatment of diarrhea is Diodoquin. This drug is only effective if you have intestinal amoebas and should only be taken under the direct supervision of a medical doctor.
When to contact a medical doctor:

If you experience symptoms of dehydration (dry mouth and dry skin), intense abdominal pain, more than 10 evacuations per day, or if you have a fever above 38.5 degrees Celsius. If you experience, both vomiting and diarrhea at the same time, you should see a doctor immediately.
Doctors instructions:

Drink as many liquids as you can tolerate. The more you drink the more quickly you will recover. You have to replace the fluids that you lost from the diarrhea to prevent dehydration. Avoid irritating and greasy foods Get lots of rest and do not attend classes or excursions (with presence of a fever). Avoid the discotecas (dance establishments) and bars until completely recovered!
Symptoms include:

-Stomach pain, pushing or excessive bearing down with evacuations. No bowel movement for 36 hours. A change from your regular bowel patterns. Distended abdomen.
How to prevent:

Drink lots of water! This is the number one way to prevent constipation. The consistency of foods in Mexico as well as your change in diet will require you to aid your intestines in the excretion of waste. Juice also can be helpful. APPENDIX VI - HEALTH ISSUES - 7 Exercise! Your intestines cannot do their job of peristalsis (movement of feces from top to bottom) if you are sedentary. Try to walk or dance or engage in some type of physical activity throughout your stay in Mexico. Eat fruits with skin for bulk (please make sure this skin has been thoroughly washed in purified water or has been sanitized by your family first). Eat fruit: papaya, oranges, mandarins and grapefruit. Avoid eating an excess of starchy foods. Find ways to cope with stress
Suggested diet to follow if you experience constipation:

Lots of liquids. Avoid the following foods that cause constipation or exacerbate constipation when eaten in excessive amounts: a) rice; b) guayabas; c) apples; d) tortillas. Available treatments include the following:
After one day or two days without a bowel movement, the following drug is available over the counter in Morelia and is effective in facilitating bowel movements: Anara. The safe dosage for this drug is one tablet every day. Try not to take it before you go to bed to avoid running to the bathroom throughout the night, which will result in loss of sleep. A home remedy reported by some doctors is to drink warm lemon-water. Warm water in the morning helps stimulate peristalsis (contraction of the intestines), but the lemon juice probably only adds flavor.
When to contact a medical doctor:
If you experience intense abdominal pain. If your stomach is distended or appears swollen. If you see blood in your feces. If you have not had a bowel movement for over three days. If you have a fever.
Prevention and appropriate treatment of constipation should be taken seriously. It can result in serious intestinal
obstructions that can consequently cause a generalized toxic infection of the stomach and intestines, as well as
It is very easy to become dehydrated at high altitudes. Because the air in Morelia is both thinner and dryer, your
lungs have to exhale increased amounts of water from the body because the air doesn't have as much oxygen. This
means that even at rest, your body requires more fluids to function. Also, at high altitudes your thirst mechanism is
suppressed, which means that your body may not send you signals that it is needs water. Thus, it is imperative that
you MAKE YOURSELF drink fluids, even when you might not feel thirsty. Also, the heat in combination with the
high altitude will further predispose you to becoming dehydrated. If you don't drink a seemingly inordinate amount
of liquid, then you're liable to become sick.
Symptoms include:
Dry mouth: The inside of your mouth is so dry that if you stick your finger inside your cheek that your finger will stick to the surface. You only urinate small amounts of urine and do not urinate as often as you usually do. The color of your urine is a dark yellow.
How to prevent dehydration:
Drink lots and lots of fluids. If you can't drink water, drink juice. Try to avoid too many caffeinated drinks because caffeine is a diuretic, which will cause you to urinate more, and consequently deplete your body of more fluids. APPENDIX VI - HEALTH ISSUES - 8 Avoid excessive intake of alcohol. Remember that alcohol produces dehydration in itself and that this further taxes your body's energy and fluid needs at high altitudes. If you experience a hangover you must significantly increase your fluid intake! Protect yourself from the effects of the sun. People can lose excess fluids through sweat and heat exhaustion.
Suggested diet to follow if you experience dehydration:
Avoid alcohol at all cost. This will severely complicate your fluid and electrolyte balance even further. Drink lots of purified water or any liquid that is easily accessible.
Available treatments include:
Pedialyte (although packaged for infants) is an excellent solution that is available over the counter at grocery stores and pharmacies. It replaces both the fluids and electrolytes that your body so desperately needs. Some Mexican doctors suggest the following cocktail solution: Fill half a glass full of mineral water and mix with half a glass of apple soda (refresco de manzana). Yet another rehydration cocktail that may be helpful includes: 4 cups of boiled water, 8 teaspoons of sugar, 1/4 teaspoon of salt, and 1/4 teaspoon baking soda. If baking soda is not available, then add another quarter teaspoon of salt.
When to contact a medical doctor:
If you have a significant decrease in urination. You experience excessive thirst. If you remain dehydrated after increasing fluids and drinking rehydration cocktails.
Doctor's instructions:
Avoid the sun. Walk in the shade. Avoid excess alcohol. Do not continue to drink liquids if you are vomiting and unable to keep fluids down. This will only further complicate your fluid imbalance. Call a doctor immediately.
Over-exposure to the sun can be dangerous. The most obvious danger is sunburn. Each year, some 300,000 cases of
skin cancer are caused by over-exposure to the sun. At higher altitudes more of the sun's ultraviolet rays will
penetrate your skin. People burn much more quickly at higher altitudes regardless of the temperature outside.
Symptoms include:
Redness or tenderness to the part of the body that was exposed to the sun.
How to prevent sunburn:
Do not try to get a suntan in one day. Begin with 30 minutes in the sun and slowly increase your exposure. Avoid the sun between 10AM and 3PM when it is the strongest. Understand the importance of the use of sunscreen. Sunscreens prevent the rays responsible for both tanning and burning from reaching our skin. You can compare sunscreens by their Sun Protecting Factor (SPF) rating. The larger the SPF, the greater the protection. However, research indicates that sunscreens with an SPF less than 15 are not very effective. Most sunscreen products wash off easily. Be sure to maintain a layer of sunscreen on exposed skin by re-applying it every so often. Do not forget to apply sunscreen in areas that tend to be forgotten such as: the ears and back of the neck. More frequent application is needed if you swim or perspire heavily. Know your limitations and stick to them. Light-skinned, blue-eyed people are most sensitive to the effects of the sun. People who are taking oral contraceptives, tricyclic antidepressants, or sulfa and tetracycline antibiotics, are at risk for further sun damage because these drugs cause photosensitivity. Protect yourself by wearing clothing with long sleeves and getting lots of shade. Protect your eyes with sunglasses. U-V rays damage the eyes and can cause macular degeneration as well as cataracts. APPENDIX VI - HEALTH ISSUES - 9 Suggested diet to follow if you experience sunburn:
Drink lots of liquids to replace the moisture and fluids that were lost from your body.
Available treatments include:
Pain management: Adults can take 2-3 aspirin tablets up to three times a day. The aspirin usually relieves the pain. If not, there are other non-pharmacological measures that can be employed. For pain: Silvadene cream-apply to affected areas. Not easily accessible in Mexico, but is available with a doctor's prescription in the United States. Be cautious when applying regular lotions or creams. They can further irritate the skin and increase the burning sensation (especially perfumed lotions). Some home remedies: Yogurt spread: Spread yogurt on the affected area for twenty minutes and then rinse with lukewarm water. Tea bags. Pat your sunburn with wet, cool tea bags.
When to contact a medical doctor:
If your skin blisters. This is important because you are at increased risk of developing infection if there is a break in the skin. Skin breaks are perfect entry for bacteria. If you are dehydrated or begin vomiting.
Doctor's instructions:
Stay out of the sun. Drink lots of liquids to replace fluid losses and prevent dehydration. MISCELLANEOUS HEALTH CONSIDERATIONS

Specific to Women
It is not uncommon for women to experience an extreme change in their menstrual cycles. As a matter of fact, many
women report missed periods or an actual increase in the amount of their normal flow. Do not be alarmed by these
changes. It is more common than not to experience irregular periods. The exact reason has not yet been identified in
research, however, doctors believe that some of the contributing factors include the following: a) the stress of being
in a new environment; b) a sudden drop or gain in weight related to a different diet; c) altitude. It is not necessary to
consult a physician unless you are experiencing some other related symptoms that might concern you.
Glasses/Contact Lenses
It is advisable to take an extra pair or contact lenses, as well as a copy of your eyeglass prescription, and an eye
lubricant like Visine or Murine.


If you need prescription drugs (such as heart pills, asthma medication, etc.) and/or over the counter medicines, make sure you have an adequate supply for your entire trip. Also, take a letter from your health care provider describing the name of the drug, and the proper dosage. This could be useful in an emergency. Keep medication in original container. Add cotton to half-full bottles to fill space and help avoid pill breakage during flight. Protect medications from heat. If you take regular injections and need to carry syringes, carry a doctor's prescription for them. Essential medications should be carried with you rather than checked in baggage. Cards/Bracelets for Medical Conditions or Allergies
A card or bracelet indicating specific problems (diabetes, seizures, heparin-therapy, allergies, etc.) could be useful in an emergency situation. This also includes allergies to foods. If you have allergies, please specify what happens to you during this allergic reaction (local skin reaction or can't breathe, etc.). Medical History
If you have a chronic disease or if you have recently been diagnosed with a new disease, a brief summary of your medical history from your health care provider would also be useful in an emergency situation. APPENDIX VI - HEALTH ISSUES - 10 Purchasing medications in Mexico
Try to avoid it. It is important to distinguish that individuals who sell medications over the counter in pharmacies or farmacias in Mexico are neither licensed nor qualified to dispense medications or provide consultations regarding the best over-the-counter remedy for the ailment that you are experiencing. These individuals are not trained health care professionals, and their recommendations should not replace the professional consultation of a medical doctor. Avoid over-the-counter remedies. These remedies may contain substances capable of causing severe side effects. Some of these substances have been banned in the United States because of their health hazards. Seemingly innocuous remedies such as cough syrup or fever concoctions may contain hazardous drugs. Rule of thumb: drugs expire in one year. Do not purchase any item from the drug store that has not been properly sealed. FOR FURTHER INFORMATION ON HEALTH RELATED MATTERS PLEASE CONTACT



In Pharmacy, IMS MAT Jan 2011 To Fever and Pain INCLUDES DR. KEELY S TIPS Effective relief you can trust A Parent's Guide to Fever and Pain The content of this guide has been drafted in conjunction with Dr. JimKeely, who has spent 6 years working in Paediatrics at three of the mainteaching hospitals in Ireland. Dr Keely entered general practice in 1994and currently works as a GP at the Seabury Medical Centre in Malahidewith a special interest in Paediatrics. He is also the father of five childrenand gives us his personal top tips on how to deal with pain and fever.

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