Travel Medication & Health Guide for Travelers in Pakistan

Note: This article is only for educational purposes. Do not take any medicine mentioned below without the consultation of a professional doctor.

Introduction

A trip to northern areas in Pakistan is always filled with enthusiasm and excitement but when suddenly we get nausea during travelling or feeling unwell, it spoils the fun of the whole trip. Moreover, if you don't have proper medications and guidance then how will you treat your sickness? It makes the situation worse. A sick person loses his interest in everything around and becomes lethargic. He cannot enjoy the beautiful scenery of mountains, pleasant weather or delicious meals at various places.

Often we feel shortness of breath and get tired easily while climbing the mountains. It happens due to the low level of oxygen in air at high altitudes leading to Altitude Sickness or hypoxemia- low level of oxygen in blood- the body has to supply more oxygen to restore breathing. During travelling or climbing mountains, you can feel motion sickness, elevation sickness, nausea, severe headache, dizziness, vomiting, fever etc. It is important that every traveller must have all essential medicines along with other stuff and also the basic knowledge about these medicines is known. Don't worry, the general information about travelling medication is mentioned in this article. Now we will talk about the best medicines and smart tips that are essential to ensure a healthy trip.

What is Acute Mountain Sickness?

As it is discussed earlier about altitude disease, acute mountain sickness (AMS) is main disease of that type. When we climb high mountains, usually 8,000 feet above sea level, the air gets thinner and atmospheric pressure decreases. Therefore, the brain and blood receives less oxygen with every single breath, leading to a condition biologically known as Acute Mountain Sickness.

When oxygen level gets lower on the mountain, the brain orders the lungs to breathe faster, in turn more carbon dioxide gets outside of the lungs. It makes the blood pH alkaline that slows down breathing and increases the shortness of oxygen. In order to get oxygen, the brain nerves dilated which results in swelling and severe headache. That is the complete mechanism behind acute mountain sickness.

Symptoms of Acute Mountain Sickness

Acetazolamide for Altitude Sickness

The most effective medicine for mountain altitude sickness is Acetazolamide, commonly known by the brand name Diamox, which is actually a Carbonic Anhydrase Inhibitor (CAI), but you must consult with your physician before taking this medicine, if you have some other inherited diseases such as diabetes, hyper tension, or other heart related issues.

Travel doctors also prescribe Dexamethasone under the brand name Decadron for the patients facing severe altitude disease or High Altitude Cerebral Edema (HACE). This medicine saves a patient's life by reducing pressure and swelling of the brain immediately.

How it works?

Here, you can understand its working in body. Acetazolamide acts on the kidneys to remove bicarbonate ions from urine. In turn, the blood becomes slightly acidic and signals our brain that carbon dioxide is increased in blood. That false signal compels our lungs to breathe deeply. In this way, more oxygen gets into our body and recovers breathing. This drug simply speeds up the natural process of acclimatization that usually takes three to four days to complete by the natural process of body.

Nifedipine to Recover Shorten Breath

According to CDC guidelines, another drug Nifedipine with a brand name Procardia or Adalat is given to the patients who got shorted of breath terribly on getting on a mountain. It is a life saver drug when shortness of oxygen leads to High Altitude Pulmonary Edema (HAPE) in which lungs are filled with fluid. It keeps the blood vessels of the lungs open and normalizes the blood pressure in order to remove pressure on the lungs.

Sildenafil - another alternative

If that drug does not suit any patient, then an alternative to it is Sildenafil, with brand name of Viagra or Revatio. It is provided by the physicians for HAPE. It simply relaxes the lungs’ veins by which lungs get blood at low levels of oxygen and breathing takes place. This is the off-label use of Sildenafil drug because it is actually used for another medical conditions.

Motion Sickness

The more beautiful the trip to mountains is, the more challenging is the way to reach there. It is mandatory to travel through narrow, dangerous, and steep pathways to reach a beautiful mountain peak. To fulfill your dream mountain trip, you have to cross these steep and winding roads. When your car has to move through these curved pathways and to take turns constantly, it gets jerked. At this point, the passengers inside the car get unwell all of a sudden. Their heads swirl and feel like vomiting. Such an internal condition of any person due to the constant and unexpected movements of the car on the route to the mountains is Motion Sickness. Other names for motion sickness are Car or Travel sickness as it mostly occurs in a car or train journey. Its medical or scientific name is Kinetosis that comes from a Greek word, “Kinein” meaning, the disease due to motion or movement.

Often people think that motion sickness is related to stomach disorders or weakness. It is actually caused by the conflicting signal to the brain called neural mismatch or sensory conflict. It gets signals from three important body parts to maintain mind-body balance. Firstly, our eyes check whether our environment is dynamic or static. Secondly, the fluid-filled internal ear, vestibular system, has numerous small tubes that can sense motion, speed, tilt, and direction. Finally, muscles and joints can sense the pressure on the body and sitting posture.

How does it work on the way to the mountains?

When you sit in the car that travels across these winding roads, your internal ear system senses that movement completely due to constant turns and brakes on the inclined roads. It sends a signal to the brain that, “We are moving fast and taking turns.” Subsequently, if our eyes are stuck to anything in the car like reading a book, using a phone or staring at the front seat of a car. Then, they send an opposite signal to the brain that, “our surroundings are static inside of the car and we sit at one place silently.” In this way, the human brain gets two opposite signals from ears and eyes. It creates an unnatural confusion that the brain considers as a symptom of any toxin or any poisonous effect. As a result the part of the brain controlling vomiting triggers the vomiting signal instantly to prevent itself.

Sensory Conflict Affects the Brain

When this sensory conflict affects the brain, then following symptoms appears in the passenger:-

• Nausea and Vomiting: the biggest and clearest symptom of travel sickness.
• Cold Sweating: the complexion of a passenger gets pale and cold sweat appears on his face and hands.
• Dizziness and Headache: the head gets heavy and feels that everything is swirling.
• Fatigue and Irritability: feeling severe restlessness, yawning again and again, and not wanting to talk to anybody.

Time to Take Medicine

According to medical experts, the medicines for motion sickness should be taken thirty to sixty minutes before the start of a journey to get its proper benefits. Because after the vomiting starts, the stomach can't absorb the medicine well.

Medication for Motion Sickness

For this antihistamines or motion sickness patches are used. Antihistamines block allergy and vomiting receptors in the brain. Scopolamine patch is an anticholinergic that blocks a chemical named acetylcholine which sends vomiting signals.

Antihistamines

Medicines like antihistamines include Dimenhydrinate that is known by the market name Gravinate or Dramamine. It is the most widely used and affordable medicine of all. It blocks the over-stimulated signal successfully from the internal ear to the vomiting center. Another effective antihistamine is Meclizine, its benefit is that it causes less drowsiness or laziness as compared to the use of other medicines.

Both Dimenhydrinate and Meclizine are generally available on the drug store counter. But if you are already taking any medicine for a disease, always consult your doctor before taking them. Don't take these medicines without consulting the your doctor or physician.

Scoplamine Patches

Scopolamine patches, known as Transdermal Patch, are also used for the treatment of motion sickness. It is actually a small medicine patch that sticks to the skin of the backside of the ear before leaving for the journey. The medicine in the patch slowly gets into the body through skin and it is considered best for mountainous journeys all over the world.

It is Prescription Only (Rx) medicine in many big countries like the USA but it is also available without a prescription in Asian countries like Pakistan, India etc. It should only be taken in the consultation of the physician because it has more significant in side-effects, like severe dry mouth, blurred vision, and drowsiness as compared to other tablets for travel or motion sickness. So, it should not be taken without proper prescription at all, or consultation with proper physician. Since many of these medications cause drowsiness, lethargy and slow down the reflexes, drivers should not take them at all, or never drive before five to six hours after taking it.

Other Common Travel Illnesses

While traveling, you have to face many other illnesses such as muscles pains, muscles stretches, excessive tiredness, etc. When people leave their own local town environment, food and water and move to other areas, their immune systems take time to adjust according to new changes. Following illnesses are most common in travelers.

The basic pain-relievers such as antacids and ORS are Over-The-Counter medicines, but stronger medicines like antibiotics and anti-diarrheal pills must be taken in consultation with a doctor.

Diarrhea or Stomach Upsets

The most significant reason for the traveller’s stomach upset is water, contaminated food and poor hygiene standards in new areas. It results in stomach cramps, food poisoning, gas or bloating and frequent trips to the toilet.

Treatments of Diarrhea

ORS, common name Nimko, is the most important to fulfill the deficiency of water and electrolytes in the body.

Loperamide, also known as Imodium, is used to treat diarrhea or loose motion, immediately in emergency situations.

Metronidazole, Flagyl, is used if stomach infection is severe and you need immediate treatment while traveling.

Fever, Fatigue and Body Aches

Due to long journeys, improper sleep and sudden weather change, going to a cold area from a hot area, the body aches, headaches, or often mild or high fevers occur.

Medication for Body Aches

Paracetamol, or Panadol/Calpol, is the primary and safest option to treat fever or mild pain.

Ibuprofen, or Brufen, is the best treatment if there is a severe pain and swelling of muscles and joints due to hiking or long travelling.

Heartburn and Acid Reflux

During the journey, due to intake of spicy foods, fast food, or irregular food intakes results in heartburn, acidity, and bloating that spoil the fun of the trip.

Medication for Heartburn

Antacid Tablets, or Syrup like Gaviscon/Mucaine, treats heartburn in minutes. Famotidine, or Omeprazole/Risek, is taken on an empty stomach to stop acid reflux before occurring.

Sprains, Cuts and Blisters

During hiking or climbing in hilly areas, you may get blisters, sprains or small cuts. So you must have basic First-Aid box to treat these common problems.

Important First-Aid Stuff

Band-Aids : to cover up small cuts and blisters.

Pyodine or Polyfax Ointment : an antibiotic cream to clean and protect cuts from germs.

Crepe Bandage : to support sprained hands and feet.

Allergies and Skin Reactions

They occur due to dust, plants, pollen, or allergic reactions to new food. Its symptoms include sneezing, watery eyes or runny nose, redness on skin or itching.

Medication for Allergies

Antihistamines, or Cetirizine/Rigix/Fexet, provides instant relief from sneezing, allergies and flu.

Hydrocortisone Cream can be applied on skin itching and swelling due to stings of wild plants, insects, or sunlight.

One must seek a doctor's advice if severe fever or stomach infection persists during the trip.

Smart Natural and Emergency Tips

• Always pack all essential medicines along with a first aid box.
• Never take any travel medicine without a doctor's consultation.
• Always get a fitness checkup before travelling.
• Always carry a prescription with generic formula names.
• Take motion sickness medicine before the start of the mountainous drive.
• Mix 1 sachet of ORS daily in water or drink purified water to fight dehydration.
• If a headache or dizziness persists, descend 1,000 feet immediately.
• At high altitudes, avoid taking heavy sleeping pills.
• Always know about local rescue (1122) and nearby hospitals before travelling anywhere.

Medicines in Your Backpack

You must have these medicines in your backpack before starting your adventure trip.

• Panadol: for fever
• Disprin: for pain
• ORS: for dehydration

Include these medicines in your first-aid box with proper doctor or physician's advice.

• Gravinate: 30 minutes before for nausea
• Diamox: for altitude sickness
• Imodium: for stomach upsets

Stop at Pharmacy for Required Travel Medicines

Before starting your journey, stop at the major pharmacy in the major urban city to purchase required medicines for your first-aid kit. Purchase all core medications depending upon number of travelers in your group.

In remote valleys like Fairy Meadows or Kharmang have very limited pharmacy options, but limited options of pharmacies are available in the major hilly towns such Skardu, Gilgit, Swat, or Naran. The more advance level of pharmacies are available in major urban cities like Lahore, Islamabad, or Rawalpindi.

Prescriptions for Special Medicines

For special medicines, one must carry the original prescription and doctor's notes. Keep all of the medicines in their original labeled pharmacy packing or labels with doctor's note or prescription to present at airport security or various checkpoints at regional boundaries.

Water Purification and Hydration

It is recommended to maintain strict hydration mechanism and water purification systems to avoid issues related to drinking water. One must avoid drinking local tap water or direct stream water. For this purpose, use bottled mineral water, portable water purification tablets, and UV filters. Use water mixing with ORS daily on the active summer treks while trekking.

Acclimatization before move further

While trekking, one must set have a acclimatization planning to pace ascents to avoid rapid Acute Mountain Sickness. When one is traveling from low valleys such as Skardu at an elevation of 2,200 meters into a high-altitude plateaus above 4,000 meters like Deosai National Park, or K2 Base Camp. One must allow time for rest and acclimatization minimum one or two days rather than rushing straight to achieve final destination at maximum elevation in single day. For more difficult or mountaineer trekking, this acclimatization must be five to seven days to adjust your body with the local environment.

Conclusion

I want to conclude this information-purpose article by saying that the beauty of Northern areas in Pakistan like Naran, Kaghan, Nathia Gali, Hunza etc is so captivating, we lost in it until we are not sick. So, we should know the basic knowledge about travelling diseases and their medication. The purpose of this article is to pre-plan your trip by checking weather, packing essential medicines with first-aid kit, following smart tips etc. In this way, you can enjoy the whole trip without any troublesome and return your home with a healthy and memorable hilly trip.

Medical Disclaimer: The information provided in this article is for educational and informational purposes only. It does not substitute professional medical advice, diagnosis or treatment. Always seek the advice of your physician or a certified healthcare provider with any questions you may have regarding a medical condition or before starting any travel medications.

Are you planning a trip above 4,000 meters in high-altitude plains? Read complete travel and safety tips in our Deosai Plains Travel Guide.