By Dr David Delvin

These days, retired people are great travellers, aren't they? A good deal of today's tourism industry is geared to the needs of the over-50s. Cruise ships take tens of thousands of 'retirees' (which is the American expression!) to visit destinations all round the world. Some retired folk go and explore the Nile or the Amazon. Rather larger numbers go to Mallorca or the Costa Del Sol etc..

So are YOU planning a foreign holiday this year? If so, I hope you enjoy it very much. But before you go, do please take a minute to think about the possible health risks. The fact is that a lot of people get SICK during their overseas holiday - and sometimes the consequences can be very serious indeed.

Therefore, be prepared! This article will show you how.

MEDICAL INSURANCE

It's lunacy to travel abroad without making sure you have adequate medical insurance. That advice is particularly important for people over 50 - who are, after all, the ones who are most likely to get sick.

If you feel ill on (say) a vacation to Florida, you could easily find yourself with hospital bills totalling a million dollars! So be certain that you've taken out a policy which will cover such eventualities.

Now if you're going to a country which is part of the European Union, you should certainly opt for the additional protection of getting an 'E111' form - which entitles you to a lot of free or low-cost medical help in EU countries.

Obtaining this form is far easier than it used to be. You just go to the Post Office and ask for one, then fill it in, and ask the sub-postmaster to stamp it for you. Taking it with you to Europe gives you a considerable sense of security health-wise. But you should definitely carry private insurance as well.

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AIRLINE THROMBOSIS

Are you flying this year? Well, there's been a lot of publicity of late regarding the dangers of getting a CLOT (a thrombosis) while on an aircraft.

This condition is sometimes called 'Long Haul Thrombosis' or 'Economy Class Syndrome'. But these are rather misleading terms, since it can occur on short flights, and in Business Class or First Class.

What's VERY important to grasp is that thrombosis is much, much commoner in older people. There is an appreciably increased risk in the over 55s. But the greatest danger is to the over 70s - particularly if they have a family history of clotting.

What exactly happens in this disorder? It's like this.

When you're sitting down for a long period, without moving your legs, a clot may easily form in one of your calf veins. This might just produce PAIN and SWELLING in the leg.

But unfortunately, the clot sometimes travels up through the veins and the heart - and then 'jams' in the lungs. This is a really serious condition, called a 'pulmonary embolism'.

The newspapers often confuse it with a heart attack, but it's not the same thing at all.

The brutal truth is that it can kill you in matter of minutes. Possible symptoms include: chest pain, collapse, and sometimes coughing up blood.

Apart from the over 55s, other travellers who are particularly liable to it are:

· Smokers;
· Women who are on the Pill;
· People who've already had some sort of thrombosis.

You really do need to take this threat seriously. Indeed, if you're going on ANY long journey when you're going to be sitting down for several hours (even if it's only a car or coach trip), take these precautions:

· During the flight (or other journey) keep FLEXING your calves and moving your legs around;
· Whenever possible, take a stroll up and down the aisle;
· Don't smoke;
· Don't get dehydrated (in other words, drink plenty of water);
· Avoid having a lot of alcohol;
· Consider wearing the new 'Anti-Thrombosis Socks,' which you can get reasonably cheaply from chemists (not on the NHS).

If you have had a previous thrombosis, then you should definitely see your doctor a good while before you go. Medics may sometimes prescribe anti-clotting agents for travellers. But if your doc says that you shouldn't travel at all, take her advice.

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TRAVELLER'S TROTS

'Gyppy tummy' infections really are the curse of many foreign holidays! For instance, in Mexico, about 40% of tourists will get 'Montezuma's Revenge'. There's also a very high incidence of 'gut rot' in Asia and Africa.

Tour operators may suggest to you that it's all due to 'unfamiliar food'. But in general, it's due to GERMS in grub or drink. Alas, outside industrialised countries neither food nor drinking water can ever be regarded as entirely safe!

PRECAUTIONS. Here are some commonsense precautions which you can take in hot countries:

· Avoid salads, unless you can be SURE they were washed in clean water;
· Similarly, avoid fruit or uncooked vegetables - which might well have been rinsed in sewage-contaminated water. (But PEELED fruit is usually OK).
· Steer clear of any cooked food which has been standing around for ages;
· Don't buy grub from street vendors;
· Don't eat ice cream (or anything else with ('creamy') UNLESS it's from a reputable outlet;
· Stick to bottled or boiled water.

TREATMENT. When going to a hot country, take some anti-gyppy tummy medication with you. The NHS doesn't pay for this, so you'll have to buy it at your local chemist's.

Good things to take are:

· Packets of oral rehydration salts, such as Dioralyte (these can be life-saving);
· Diarrhoea-stoppers. Although British doctors aren't usually very keen on these pills, they can be very useful if your in BIG trouble on a long journey. Popular brands include Imodium and Lomotil.

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IMMUNISATIONS.

There's no denying the fact that a lot of the hotter countries of the world are still full of nasty bugs which you could catch. So it's essential to get yourself all the necessary immunisations.

For many people, the best place to obtain your jabs is their own doctors' practice.

Usually, a particular nurse has been deputed to handle all the holiday vaccinations, and you should make an appointment with her to sort out which injections you need.

An alternative is to go to one of the many PRIVATE travel medicine clinics which have sprung up in recent years. Among the best are the British Airways clinics - which it's OK to use even if you're not flying by BA. They have a great advantage in that they receive up-to-the-minute reports about precisely which outbreaks of disease are going on in various parts of the world.

Please make your jab arrangements well before you go; quite a few people turn up at GPs surgeries or travel clinics just a couple of days before departure - when there's simply not enough time to do the full course of immunisations.

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WHAT JABS WILL YOU NEED?

I can't give you a complete guide to jabs - because the world's health situation changes so frequently. But here are a few general tips:

· For travel to the USA, Western Europe, Australia and New Zealand, no special jabs are required. But travellers should make sure that their immunisation against polio and tetanus (lockjaw) is up to date.
· For travel to South America and much of Africa, yellow fever immunisation is necessary. And make sure you carry your certificate with you when you leave Britain.
· Many poorer areas of the world have very high rates of TB and polio. If you're going there LONG-TERM - or are going to be in close contact with the population - you should make sure that you're protected against these diseases.
· Similarly, many economically-deprived parts of the globe have extremely high hepatitis rates. If you're going for a long trip - or 'living rough' - you should most certainly get yourself protected against hepatitis 'A' and hepatitis 'B'.
· Typhoid is endemic (that is, constantly present) in many countries of the world. If you're going to visit one of these places, you really must have typhoid immunisation first. (An oral vaccine is available these days - which is nice for those of us who get violent reactions to the jab!).
· However, the vaccine doesn't give complete protection, so you need to take great care to avoid food or water which might be contaminated by human excreta - for that is how typhoid is passed on.

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MALARIA

If by any chance you're an old soldier, you'll know that malaria is a heck of an unpleasant infection and sometimes it can kill you.

Yet every year, several thousand travellers come back to this country with malarial infections. This is usually because they haven't taken their anti-malarial tablets.

There is NO jab for prevention of malaria, so you really have to take the pills. Which type of pill you need to take depends on where in the world you're going - so be guided by the doctor or nurse.

When you're at your destination, you should also take precautions to avoid being bitten by mosquitoes. That's easier said than done! But the important points are:

· Mosquitoes mainly bite after dark. So 'cover up' from dusk onwards.
· Wear long sleeves and long trousers in the evening. Don't give them a flash of bare leg!
· Treat all exposed areas of skin with insect repellant.
· When you have a light switched on (which attracts mozzies) either keep the windows tightly shut, or make sure that adequate insect screens are in place. If necessary, sleep under a net!

Well, have a great holiday - despite everything!!

Q. I'm flying to Australia to see my son. Should I get those anti-thrombosis socks?
A. Only if your own doctor thinks that you're 'at risk' of thrombosis.

Q. My wife and I are going to North Africa. Is it worth taking sun cream?
A. Absolutely, sir! The incidence of skin caner among fair-skinned British people is now very high - so you need to protect yourself while you're in a sunny country. It's worth buying the cream in the UK, because it can be difficult to get (and very pricey) when you're abroad. If you have a 'bald pate', please don't forget to protect that. Unfortunately, a lot of older chaps now get nasty skin lesions (caused by the sun) on the bald area of the scalp.

Q. I'm a man on my own, and each year I take a holiday somewhere on the Mediterranean. Most of these trips end up in a 'holiday romance'. What I want to know is this: is there any risk of HIV at my age?
A. HIV can strike at ANY age, sir. All I can tell you is that the further SOUTH you go, the greater the danger of HIV. For instance, it's far commoner in countries that border the Med than it is here. I should pack some condoms, if I were you.

Q. I'm about to take out travel insurance. My wife and I are not too well physically. Could I just 'not mention' our illnesses to the insurance company?
A. That would be illegal, sir. And if you or your wife fell ill while on holiday; the company might get suspicious and refuse to pay. So please don't try it.

Q. My health isn't good, but id like to go on one final cruise. Am I right in thinking that if I died on board, I'd be buried at sea?
A. Almost certainly, ma'am - unless the ship were close to port. But please don't go on this cruise unless your GP thinks that your health is good enough.

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Q. I wanted to have that blood test for prostate cancer, but my GP refused. Why?
A. Because the test isn't very good. If you're determined to have it, you could consider getting it done privately.

Q. What is 'Lyme disease'? My husband suffers from this debilitating condition.
A. Lyme disease - which is called after a town in America - is caused by a germ which is transmitted by the bite of a tick. The tick live on deer, dogs and (in the USA) racoons. Unfortunately, they fall off these animals onto leaves of GRASS - and they bite human beings who walk through the grass. Areas where people are particularly liable to contract Lyme disease include North Eastern America and the New Forest. Walkers should cover their legs in Lyme disease areas.

Q. I frequently suffer from ingrowing toenails, and my doctor and the chiropodist say that this is more common in older people, because their toenails become more hard. Can you comment?
A. Ingrowing toenails are common at all ages, but when you're older, you have had more time to develop them. They are a nuisance - but you're quite right in going to a chiropodist, because generally their treatment is much superior to what us medics can offer.

Q. I am now 65, and I worry about breast cancer. I'm told that I am now 'too old for screening'. But is this true?
A. No, ma'am. Although the authorities have publicised the availability of x-ray screening (mammography) for women aged 50 to 64, there hasn't been much publicity about the need for the over 65's to be screened. In fact, the incidence of this disease in over-65s is very high indeed. So you should insist on getting yourself 'done'. You have the right!

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