Author Archive

Permethrin – a secret weapon against mosquitoes

Permethrin is a special insecticide that enables clothing to kill or repel mosquitoes

Wearing treated items will significantly decrease the number of bites you get. Treated bed nets have been shown to be four times more effective than untreated nets. When you wear treated clothes, you still need to use repellent on exposed skin. You can buy items pre-treated (especially bed nets) or treat items yourself with commercially produced permethrin packs. Follow the treatment instructions carefully to ensure the best effect. Do not throw any unused solution down the sink. It is toxic to fish. Follow the disposal instructions on the pack.

Treated articles which are immediately stored in a sealed plastic bag, will retain effectiveness for 12 months until usage is begun. A permethrin impregnated mosquito net is effective for 3-6 months of regular use. The solution wears off as well as washes off. Treated clothes are said to be active until the fourth normal wash. Do not iron treated clothes.

Is permethrin safe?
Yes. Permethrin is related to the naturally occurring pyrethrum from the flowers of a type of Chrysanthemum. Once the fabric is treated and dried, permethrin has no vapour action and nets can be used safely, even around sleeping children. Should a young child suck the net, they will not suffer any ill effects. Treated items are not more flammable. There are rare reports of persons developing a minor skin rash after wearing treated clothes.

• Posted on August 30, 2013
• Posted in Travel health tips
• Tags: Mosquito, Tips

Mosquito Avoidance

Dr Deb Mills

Moisture, warmth, carbon dioxide and odour all attract ‘mozzies’, and some unlucky people seem to be genetically more delicious to mosquitoes.

Cover up – long sleeved, light coloured clothes
Try and avoid being outside when they are biting. If you are outside between dusk and dawn, wear treated, long sleeved shirts, long pants, and long socks. Light coloured clothes are best. Dark colours attract mosquitoes. Strong scents also attract them, so avoid perfumes etc.

30% DEET is the best
‘DEET’ (Diethyl toluamide) is clinically proven to be the most effective mosquito repellent to apply on your skin e.g. Repel™ or Rid™. Repellents work by blocking the receptors on the mosquitoes antennae. A concentration of 30% DEET is recommended for adults under conditions of intense mosquito exposure. Concentrations greater than 50% DEET are usually not recommended. In field trials, DEET products on the skin have been found to be more effective than coils, ‘mozzie plants’, citronella candles, sonic repellers, and UV light lures. DEET can damage plastics, synthetic fabrics, leather and painted or varnished materials so be careful with eye glasses, cameras etc. DEET has no effect on cotton, wool or nylon or skin(!) DEET has been on the market for 45 years and side effects are rare if used properly.

Apply regularly
Apply regularly as per instructions on the bottle (for 30% DEET usually every 4-5 hours). Don’t forget your neck and ankles. Use just enough repellent to lightly cover your skin. You do not need to saturate your skin. Never use repellent over cuts, wounds or inflamed skin. After application, wipe or wash the repellent off your palms to avoid inadvertent contact with your eyes, mouth and other sensitive areas. Don’t apply repellent to children’s hands if they are likely to put their hands in their mouth. Ideally, wash off the repellent when you no longer need it.

Sleeping precautions
Sleeping in air-conditioned or well-screened rooms is the ideal. Use a ‘knock down spray’ if necessary to remove stray mosquitoes. The next best plan is to sleep under a permethrin-treated mosquito net. Check there are no holes in the net, and tuck the edges under the mattress. If mosquitoes are already inside the net, spray them with insecticide before you go to bed. As a last resort burn mosquito coils, cover exposed skin in insect repellent, and sleep next to a fan.

Did you know … mixing sunscreen and repellent?

When sunscreen is required, apply sunscreen first, wait 20 minutes and then apply repellent. Combination products are not as effective.

• Posted on August 30, 2013
• Posted in Brisbane
• Tags: Mosquito

Splitting tablets?

Dr Deb – TMA member in Brisbane  

A recent study looking at the accuracy of tablet splitting, found large variations in dose in some of the splits. Some tablets are easier to split than others, and some drugs are more dangerous than others if you get the dose slightly wrong.

The major finding of the study was this “Based on our results, we recommend use of a splitting device when splitting cannot be avoided, for example when the prescribed dose is not commercially available or where there is no alternative formulation, such as a liquid.”

Tablet splitters can be purchased from most pharmacies. More info.

• Posted on August 27, 2013
• Posted in Brisbane
• Tags: Tips

Spain

  prepared by Dr Joan Chamberlain, TMA member in Rockhampton.

Lessons learned on the Trip:

1. Be prepared and know the area you are going to. You will appreciate better what you see and find.
2. Many of the best experiences are not far away or too expensive. But be prepared to pay for inside knowledge when needed.
3. Most people will help you and appreciate you making the effort to speak at least a few basic words in Spanish eg hello, thank you, please, good buy and their name.
4. Never leave your possessions unattended and be vigilant.
5. It’s a long way to fly from Australia to Spain.

• Posted on August 27, 2013
• Posted in Rockhampton
• Tags: Spain

Tran Siberian Express

Prepared by TMA member Gold Coast

Travel Health Doctors Gold Coast clients, Kate and Matt experienced the longest and arguably one of the most fascinating train journeys of all time – the Trans Siberian Express. The couple boarded the train in Frankfurt then onward to Warsaw and St Petersburg. The official journey then commenced in Moscow. From there Kate said she was amazed by the diversity of the landscape.

“It was so brilliant to see the unexpected variety in the landscape – such eye catching scenery from European forests through to Siberian forests, snow and desert” she said

Also what surprised them was, although not travelling in the height of the winter, the Gobi desert was covered mostly in snow and when it wasn’t snowy, the land was mostly rocky instead of sandy -only a small percent of the Gobi desert is actually sand. Throughout these rocky regions of the desert, a huge number of dinosaur relics can be found.

As self adventurers, highlights for Matt and Kate along the way included a three day horseride along the Mongolian step which proved a real eye opener for them.

“It was fascinating to see nomadic families move to greener and warmer pastures – just packing up their lives and livestock and moving in groups of three or four families to an area more sustainable” Kate said.

Away for nine weeks but spending three weeks touring Mongolia, Matt also lent a hand helping a farmer herd cattle along the way. To show their gratitude, the farmer insisted Matt and Kate accompany him home where he offered his “best yoghurt” – from a bucket just sitting outside. They thought for sure the yoghurt would render them sick for days but surprisingly were okay!

Travelling throughout Mongolia the couple do recommend employing local guides.

“Due to snow and the movement of nomadic tribes to let areas grow over with grass, the roads are ever changing and you would get hopelessly lost without a guide” Kate said.

At one stage they were blocked by a huge snowdrift and had to physically dig their way out before help arrived in the form of a local landrover which pulled their car to safety.

After this, the locals again extended their hospitality insisting on bringing them home to taste their proud home brew of warm, salty camel’s milk.

“Outside of the cities especially, the locals are so appreciative, interested in us and super friendly..

“We enjoyed tasting the local food, although you never really knew what you were ordering – one cafe had dishes called “Horse and Cart” and “The Merchant’s Daughter” ..which in fact was chocolate pancakes” Kate said.
Health wise the couple left prepared and were grateful not to experience any health issues as sometimes they were nearly three days’ drive to anywhere which could remotely help them.

Travelling for nine weeks, it’s difficult to condense such a life changing trip, but both Matt and Kate were amazed and humbled by the beauty and culture they experienced.

Travelling in September/October at the end of the tourist season, proved ideal with temperatures reaching -15 at night… instead of -40 which can occur in the Winter.

Considered the longest train journey in the world, the most extended stretch Matt and Kate spent on the train non-stop was 60 hours. Their tip is that you book both an upper and lower bunk instead of just upper bunks so you have more space to relax during the day.

“The train journey was ever-changing and we so enjoyed meeting some amazing people and glimpsing cultures and experiencing adventures we could only dream about” they said.

This report has been prepared by Travel Health Doctors, Southport.

• Posted on August 27, 2013
• Posted in Gold Coast
• Tags: Mongolia, Trans-Siberian Railway

Safety of DEET (N,N,-diethyl-m-toluamide)

Insect repellents containing DEET are the most effective and the most commonly used world wide. DEET has been available commercially for over 50 years and has been studied extensively.

It is thought that DEET works by interfering with the mosquito antennae function, effectively making humans invisible to the mosquito. Generally, the duration of protection is related to the concentration of DEET. However, at a concentration of 50%, this effect plateaus. 30% DEET is the lowest effective dose.

DEET repellents have a very good safety record, when used as directed. When DEET is applied to the skin, some is absorbed into the circulation. However, if the same amount of DEET were to be taken by mouth, either accidentally, or non-accidentally, blood concentrations will be hundreds of times higher and seizures and death can result. Toxic effects have most often occurred as a result of ingestion, rather than skin application. Repellents should not be applied to the lips, mouth, sunburned skin, damaged skin, or deep skin folds, and hands should be washed after applying DEET.

The risk of disease due to the bite of an insect is far greater than the risk involved in applying DEET insect repellents to the skin. 30% DEET repellents are safe to use and are recommended for adults, pregnant women, breast-feeding women and children over 2 months of age.

• Posted on August 27, 2013
• Posted in Travel health tips
• Tags: DEET, Insect repellent, Mosquito

Wife White Knuckles – Hurning to Brisbane – in 5 hour hops

Julie Wright, Admin Staff, TMA Member Brisbane

After 10 years of dreaming, and 8 months of planning, my husband and I embarked on the adventure of a lifetime in August of 2006. (Six weeks prior to departing Brisbane, we of course consulted with Dr Deb Mills to ensure our health was optimal! ) We shared the small cockpit of a single engine Beechcraft Bonanza F33A at 10,000 feet, across half the world. Our fuel tank only allowed a 5 hour flight range, so we had to make 29 stops in 31 days. Our flight path took us – Hurning (Denmark), Copenhagen, Baden Baden, Barcelona, Corsica, Amalfi, Athens, Santorini, Istanbul, Adana, Tabriz, Esfahan, Dubai, Muscat, Karachi, Ahmedabad, Nagpur, Colcutta, Chiang Mai, Bangkok, Phuket, Singapore, Jakarta, Bali, Kupang into Darwin and on to Archerfield airport, Brisbane. To experience the many different cultures in quick succession was a fascinating experience. However, despite our careful preparation, the different terrain, along with language barriers, and unforeseen weather conditions presented both mental and physical challenges. We became known as the “Crazy Aussies” by many air traffic controllers. Sometimes we were met with an incredulous “You’re flying to Australia in that?” from commercial pilots on the ground. We planned the route with a German company that organises flight paths and permissions for cargo aircraft around the world. They successfully applied for our permissions, even organizing us to transit through Iran where we made stops for fuel in Tabriz and Esfahan. To smooth our dealings with Army and security on the tarmac at various terminals, they suggested we wear a uniform, so from Istanbul to Darwin, my husband and I wore collared white shirts with epilates and navy pants. We were seen as flight crew. We were to need it sooner than we thought.

On one occasion we had some problems that resulted in our passport stamped with the words Illegal Aliens… Our aircraft was only rated to fly in good visibility. In Esfahan, Iran, our refueling and paperwork took so long, that it was well into the afternoon before it was finalised. Problem. We had no visa to stay in Iran, only permission to transit. We were marched inside the airport under army guard. We sat for six hours in a tiny room with a young fully armed guard right beside us. We overheard the head of the police and the government officials yelling into their phones, trying to sort out what to do with us. We phoned our contacts, they called the Australian consulate. This went on and on.

At midnight we were taken from the airport, thankfully to a hotel, still under police guard – at least the guard stayed outside the room! How could we sleep with visions of being trapped in Iran forever running through our heads. The next morning, we were returned to the airport. Yet another official met with me. This time, thankfully, he had a big grin. I think he was as happy as we were, that a solution had been found. Our passports had been blessed overnight with a 7 day visa. In fact the now smiling official even warmly welcomed us to stay a few days in Iran! We made all the proper polite comments and hurried to our aircraft. As we were waiting on the tarmac, running through our flight checks, we heard a huge roar from the runway. A mick fighter took off and flew vertically at great speed in front of us. What a sight! I looked over at the Iranian police, unsure why the tower had put the mick fighter up in the air before our take off. The officials were all smiling, pointing to the fighter in the air and hands on their hearts yelling, “Ours, ours!” with much pride. Now it was our turn, my husband and I sat waiting for the radio signal from the tower that would giving permission to take off. Silence…. We watched the fighter land and be towed off the runway. Only then, were we given permission to take off. As we looked over at the smiling Iranians, we realised that we had been honoured with a display and fighter ‘send off’.

I earned the nick name ‘wife white knuckles’ after episodes like that, along with sand storms in Tabriz, dust storms in Dubai and a raging torrential storm over Singapore. The realization of our dream would not have been possible without an extraordinary team of many helpers from across the world. In 2006, we, “the Crazy Aussies”, were the 187th in the world to fly this particular route in a small single engine aircraft.

• Posted on August 27, 2013
• Posted in Brisbane
• Tags: Iran, Isfahan, Istanbul

Traveling with Diabetes

While you’re having a great time on your holiday, if you have diabetes you need to continue your monitoring and care routine.

Having meals later or more irregularly than usual, time zone changes and the heat of tropical countries can all affect how well you manage your blood sugar levels. Before you hit the road, have a look at some of these suggestions click here for info.

The Heat of Summer or the Tropics

Heat can affect your blood glucose (sugar) levels and also increase the absorption of some fast-acting insulin, meaning you will need to test your blood glucose more often and perhaps adjust your intake of insulin, food and liquids.

• Drink plenty of fluids, especially water (always bottled or boiled if in less developed countries!), to avoid dehydration. Avoid sugar-sweetened soft drinks and fruit juices.
• Check the product information in your boxes of medications to learn when high temperatures can affect them.
• If you’re traveling with insulin pens or vials, don’t store them in direct sunlight or in a hot vehicle. Keep it in a cooler if possible, but do not place it directly on ice or on a gel pack to avoid freezing it.
• Check glucose meter and test strip packages for information on use during times of high heat and humidity. Do not leave them in a hot car, by a pool or on the beach.
• Heat can damage insulin pumps and other equipment. Do not leave the disconnected pump or supplies in the direct sun.
• Undertake physical activity in air-conditioned areas, or exercise outside early or late in the day, during cooler temperatures.

Don’t Forget Your Medication

• Take more medication than you would expect to need, in case of travel delays or lost luggage.
• Keep snacks, glucose gel, or tablets with you in case you have a ‘hypo’. If you use insulin, speak to your Doctor before you go about taking a glucagon kit; this is an injection that can e given in case of a more severe drop in blood sugar.
• Carry medical identification that says you have diabetes.
• Keep time zone changes in mind so you’ll know when to take medication.
• Keep all insulin in the original pharmacy labeled packaging. Get a letter from your Doctor stating you need to take syringes or insulin pens with you.
• Take copies of prescriptions with you.

In the Air

• Place all diabetes supplies in carry-on luggage in case checked in luggage goes missing. Keep medications and snacks at your seat for easy access.
• If a meal will be served during your flight, call ahead for a diabetic, low fat, or low cholesterol meal. Wait until your food is about to be served before you take your insulin.
• Make sure to pack snacks in case of flight delays.
• Reduce your risk for blood clots by moving around every hour or two.
• More Info on using insulin pumps during flight here.

Staying Healthy

• Changes in what you eat, activity levels and time zones can affect your blood glucose. Check levels often. Stick with your exercise routine. Make sure to get at least 150 minutes of physical activity each week.
• Protect your feet. Be especially careful of hot pavement by pools. Wet or sweaty feet are more prone to tinea as well; consider taking an anti fungal cream such as Lamisil with you.
• Make sure you have all the vaccinations you need for your destination.

• Posted on August 27, 2013
• Posted in Other
• Tags: Diabetes

Riding Motorbikes in Vietnam; THINK TWICE!

… Prepared by TMA Member Narre Warren: Dr Michael Long

There is plenty of evidence statistics to suggest that Vietnam is quite simply in love with the motorbike. Motorbike travel in Vietnam was popularised further with Western TV viewers with the 2008-9 Top Gear Vietnam special where the heroic Jeremy Clarkson with his friends May and Hammond sputtered their way on feeble underpowered motorcycles from Saigon to Ha Long Bay.

“Motos” are a common sight on the roads of Vietnam and far outnumber cars. The current estimate of the motorbike population in Vietnam is approximately 20 million, one for every four and a half people of their population of 90 million; (indeed they are often the family sedan with Mum, Dad and 2 kids traveling on a small 50-100cc motorbike or motor scooter.)

Motos are not just for transporting people either. Not having a car doesn’t hold the Vietnamese back at all as you can just attach 3 metre lengths of timber cross ways across your moto, attach 30 coconuts to the back, pull a motorbike trailer behind you carrying anything, or even carry a moto on the back of your moto! (the writer observed all of these on a recent trip).

Driving on the right hand side of the road is the least of your worries riding motos in Vietnam. Road rules are often regarded as optional, motos ride on footpaths in Saigon peak hour, no one gives way at roundabouts and pedestrian crossings are completely ignored. The country’s rampant love affair with motorbikes has been associated with a substantial number of collisions; the road toll in Vietnam is approximately 13,000 per year which is 2-3 times the rate per capita in Australia.

Despite their kamikaze attitude to road rules and safety, there remains a great interest in motorbikes in Vietnam. You don’t need a license to ride a moto in Vietnam, but remember the commonest cause of death in travelers overseas is not some exotic illness like malaria, but is due to the depressingly familiar occurrence of motor vehicle accidents.

• Posted on August 27, 2013
• Posted in Narre Warren
• Tags: Vietnam

Exploring the World’s Remotest Rivers

… Prepared by Kevin Casey (visitor to Brisbane TMA members clinic)

• Posted on August 27, 2013
• Posted in Brisbane
• Tags: DEET, River