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 the northern areas in Pakistan is always a wonderful experience filled with excitement but as we get nausea during travelling or feeling unwell, it will spoil all of the tour fun. Moreover, without proper medications and guidance, it becomes difficult to treat your sickness during travel. 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 are going to climb high mountains, usually 8,000 feet above sea level, the air becomes thinner and atmospheric pressure is going to decrease below certain level. Therefore, the brain receives less oxygen with every single breath due to less oxygen in atmosphere, leading to a condition biologically known as Acute Mountain Sickness.

When oxygen level is getting lower on the mountain, the brain instructs the lungs to do breathing faster, in turn more carbon dioxide gets inside instead of oxygen. It makes the blood pH alkaline that makes breathing slow 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

Acetazolamide is one of the most effective medicine for mountain altitude sickness. It is also known by the brand name Diamox that is actually a Carbonic Anhydrase Inhibitor (CAI). Before taking this medicine, you must consult with some approved physician, if you have some inherited diseases such as diabetes, hyper tension, or other heart related diseases.

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?

You must have some knowledge about its working in body. Acetazolamide performs in kidneys to remove bicarbonate ions from urine. As a result, the blood becomes slightly acidic and that condition signals our brain about increased carbon dioxide level in our blood. It is actually a false signal that compels our lungs to breathe more deeply. In this way, more oxygen gets into our body to recover breathing. This medicine simply speeds up the natural process of acclimatization that usually requires three to four days to recover by body's natural process.

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

Sildenafil is an alternative, if that drug does not suit any patient. It is available with brand name of Viagra or Revatio. It is prescribed by the physicians for HAPE. It relaxes the lungs’ veins, so lungs get plenty of blood at low levels of oxygen and helps to smooth the breathing process. It is not the actual use of Sildenafil drug because it is actually manufactured for another medical conditions.

Motion Sickness

The more beautiful trip in mountains has a more challenging 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 sudden point, the passengers inside the car get unwell. They feel their heads swirl with vomiting like feeling. Such an internal condition of body due to the unexpected and constant movements of the car while traveling on the mountains is Motion Sickness. It is also known as Car or Travel sickness as it mostly occurs inside a car or train while traveling. Its scientific or medical name is Kinetosis that derives from a Greek word, “Kinein” that means a disease due to motion or movement.

People often think that motion sickness disease is related to stomach disorders or weakness. Actual, it is caused by the conflicting or false signal to the brain called sensory conflict or neural mismatch. It receives signals from three major body parts to maintain mind-body balance. First of all, our eyes guess whether our environment is dynamic or static. Secondly, vestibular system, the fluid-filled internal ear, has several small tubes that can sense motion, direction, tilt, and speed. Then finally, muscles and joints can feel the pressure on the body due to prolonged sitting posture.

How does brain work in motion sickness?

When you sit in the car running over the winding roads, your internal ear system senses that all movements completely due to constant turns and brakes on the inclined roads. Then it starts sending signals to the brain that, “We are moving fast and taking turns quickly.” Subsequently, if your eyes are stuck to static things in the car like using a phone, or staring at the front seat of a car. Then, your body is going to send an opposite signal as, “our surrounding is static inside the car.” In this way, your brain gets two opposite signals from ears and eyes. This situation creates an unnatural confusion or conflict that is considered as a symptom of any toxin or some poisonous effect by the brain. As a result, brain triggers the vomiting signal instantly to prevent the body from poisonous effect.

Sensory Conflict Affects the Brain

As this sensory conflict affects the brain, the following symptoms appears in most of the passengers:-

• Nausea and Vomiting is one of the biggest and clearest symptom of travel sickness.
• The complexion of a passenger gets pale and he gets cold sweat around his face and hands.
• The passenger's head gets heavy with dizziness and headache and feels as everything is swirling.
• Feeling of fatigue and irritability with severe conditions of restlessness, yawning again and again, and not willing to talk.

Time to Take Medicine

According to medical experts, all type of travel medication must be taken with due care. It is advised to take motion sickness medicines thirty to sixty minutes before the start traveling, otherwise, it becomes difficult to get its benefits. Because after the vomiting starts, the stomach becomes unable to absorb the medicine well.

Travel Medication in case of Motion Sickness

For motion sickness patches, or Antihistamines, are used. It blocks vomiting and allergy receptors in the brain. Scopolamine patch is an anticholinergic. It blocks a chemical named acetylcholine in the brain which sends vomiting signals to stomach.

Antihistamines

Medicines like antihistamines include Dimenhydrinate that is also known as Gravinate or Dramamine in market. It is the most widely used and affordable medicine of all. It blocks the brain signals from the internal ear like over-stimulated that cause vomiting. Another effective antihistamine is Meclizine. It is also effective to reduce drowsiness or laziness as compare to other medicines.

Both Dimenhydrinate and Meclizine are generally available on every drug store counter. But if you are already taking some medicines, always consult your doctors. So, never take these medicines without proper doctor or physician's consultation.

Scoplamine Patches

Scopolamine patches, also known as Transdermal Patch, are also used in motion sickness. It usually sticks to the backside of the outer ear before leaving for the journey. The medicine slowly gets into the body absorb through skin to perform its action to prevent motion sickness. It is considered one of the best treatment during mountainous journeys all over the world.

It is Prescription Only (Rx) medicine in many countries like the USA but in Asian countries, it is normally available without a prescription. But, it should be taken by the consultation of the physician due to its significant side-effects, like severe dry mouth, drowsiness, blurred vision as compared to other travel medicines for motion sickness. So, it should be avoided without proper prescription, or consultation with proper physician. Since many of these medications cause lethargy, drowsiness, and slow down reflexive action, so drivers should not take them in any case, or avoid driving before five to six hours after taking it.

Other Common Travel Illnesses

While traveling, one has experience many other illnesses such as muscles pains, excessive tiredness muscles stretches, etc. Normally, our immune system takes time to adjust the changes as move to other areas after leaving their local environment, food, or water. Due to this, most of the travelers face following illnesses.

The basic pain-relievers such as antacids and ORS are easily available over the counter, but stronger medicines like anti-diarrheal or antibiotics must be taken after doctor's consultation.

Diarrhea or Stomach Upsets

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

Treatments of Diarrhea

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

Loperamide, also known as Imodium, is an important drug used to treat diarrhea or loose motion, specially in emergency situations.

In case of severe stomach infection and one needs to have immediate treatment during travel. Metronidazole, Flagyl, is the most effective drug for that situation.

Fever, Fatigue, or Body Aches

Due to improper sleep and sudden weather change in long travels. For example, most people travel from hot area travel to an extreme cold location. Such situation becomes a reason of headaches, or body aches. In most of cases, it shows mild or high fevers.

Medication for Body Aches

Paracetamol, or Panadol/Calpol, is one of the most safest option to treat fever or mild body pain.

Ibuprofen, or Brufen, will be the best treatment in case of severe pain and swelling of muscles and joints after hiking or long traveling.

Heartburn and Acid Reflux

Due to intake of spicy or fast foods and irregular food intakes during the journey, people feel heartburn, bloating, acidity. It becomes difficult for them to continue their journey.

Medication in Heartburn Conditions

Antacid pills, or Syrup like Gaviscon/Mucaine, are best to treat heartburn in minutes. Famotidine, or Omeprazole/Risek, can also be taken with an empty stomach to avoid acid reflux before occurring.

Sprains, Cuts, and Blisters

While hiking or climbing in mountainous areas, you may get blisters, sprains or small cuts on skin. To treat these common problems, one must equip oneself with basic First-Aid box.

Important First-Aid Stuff

Band-Aids will be helpful to cover up small blisters or cuts.

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

Crepe Bandage is required to support sprained hands or feet.

Allergies and Skin Reactions

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

Medication for Allergies

In case of sneezing or flu due to allergies, Antihistamines, or Cetirizine/Rigix/Fexet, provides an instant relief.

For skin itching or swelling due to insects, stings of wild plants, or heavy sunlight, Hydrocortisone Cream can be applied for immediate treatment.

In case of persistent and severe stomach infection or fever during travel, one must consult with a doctor.

Smart Emergency Tips

• Your first aid box must contain all essential medicines.
• Never take specific travel medicine without a proper doctor's consultation.
• Before traveling, it is recommended to get a fitness checkup.
• One must carry a prescription for generic medications with formula names.
• If motion sickness is expected, then one must take motion sickness medicine before travel starts.
• Take ORS water daily, or drink purified water in case of 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) services and also have a list hospitals in that area before travelling.

Medicines in Your Backpack

For the best health guide for travelers, one must have these medicines in one's backpack before starting any adventure trip.

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

One must get a proper doctor or physician's advice before include following medicines in first-aid box.

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

Stop at Pharmacy for Required Travel Medicines

One must stop at the major pharmacy in the major urban town to purchase required travel medicines for your first-aid kit before starting journey. It is recommended to purchase all required and primary travel medications depending upon number of travelers in 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 medicines in their original pharmacy label packing or present the doctor's note or prescription at airport security or various regional checkpoints.

Water Purification and Hydration

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

Acclimatization before move further

You must have a acclimatization planning while trekking to set your pace on 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 advance level & difficult mountaineer trekking, this acclimatization must be performed for five to seven days to adjust body with the local environment.

Conclusion

I want to conclude this information-purpose article for better health guide for travelers in Pakistan by saying that the beauty of Northern areas like Naran, Kaghan, Nathia Gali, or Hunza is so captivating, we involve in doing various activities until we are not sick. Therefore, we should learn basics about travel diseases and their medications. 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 through this article is only for educational and informational purposes. It never substitute professional medical advice, diagnosis, or relevant medical treatment. Always try to seek the advice of your physician, doctor, or a certified healthcare provider for 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.