Can You Eat Healthy While Traveling for Business?

Italian chicken, with zucchini, beans and tomatoFirst in a Three Part Series:

How Tiny Efforts Create Big Wins When Eating Healthy on the Road.

Two weeks ago I while skiing at Steamboat Springs I realized how hard it is to stay healthy while eating out, even when participating in athletics.

My husband and I escaped for a long weekend to ski, relax and take in some wonderful film festivals at the Chief Theater in Steamboat Springs.

It was like skiing in a Christmas card- fresh snow, flocked trees and a clear blue sky. We were loving life and generally working up a sweat skiing amongst the beautiful trees. So we headed off to the mid-mountain lodge to see what was on the menu for lunch.

Fresh pasta, hand crafted sandwiches, and of course a grill with burgers and fries. Steve couldn’t resist a bowl of pasta Alfredo while I selected the wild Alaskan salmon sandwich on a gluten free bun with side of kale salad—it was Colorado after all!

I began eating. And eating. And eating. About halfway through the meal

I realize I couldn’t finish the sandwich.

I feel so guilty wasting all this food.
Steve reassured me, “Don’t worry this is Colorado- the land of zero waste they’ll just compost it.”

I realized I was suffering from portion distortion. Portion sizes at restaurants are enormous, 2-3 times what they should be. Everything has been super-sized.

Even in Colorado, land of the über fit and in-your-face health conscious self-appointed experts.

Where I live all the restaurants are judged by the size of their portions. People say ‘It’s a great restaurant…the food tastes good and the portions are enormous!’

Why don’t they ever say… .’the food is so tasty and the portions are right-sized’?

I am tired of having to figure out not only what do I want to eat but also how to manage the portions. Why can’t the restaurant give me the right size portions in the first place?

I’m still going to pay my bill. I’m going to tell others how delicious the food is.

Why over feed me so that I feel uncomfortable? Is that hospitality? Eat.. until you are uncomfortable and well on your way to bad health?

OK so I know that I am the only one responsible for what goes on the fork and then into my mouth. But can’t you help me out a bit here?

Why put so much tempting food in front of me and then ask me to use so much energy resisting it. Why not just right-size it in the first place?

You eat twice as many calories if you eat out than if you eat at home.
But what if your job requires travel or business over meals? Are you doomed to becoming overweight and unhealthy? How can you eat healthy while traveling for business?

What can the traveler do?

Realize the days of the clean plate club are over. You no longer have to clean your plate at every meal. Instead, start using the divided plate concept at restaurants.  Basically you assemble your meal from basic building blocks to fit on a plate divided in quarters.

Developed by USDA. It’s so easy to understand even kids can do this. Just ask them, it’s part of the health curriculum at many schools. Click here 

The plate is an 8” plate, not the grand 12’-14’’ plate often found in restaurants and fancy dish sets. Use a luncheon plate. You can get plastic ones with cartoons on them at local stores. But even better you can carry this around in your head, without the actual plate.

How to build your divided plate:

Start with the protein. Pick a lean protein, not slathered in sauce. It should be 2-3 ounces. Even if you don’t know how big 2-3 ounces is it’s easy to remember since it’s about the size of a computer mouse. Your whole grain side dish or bread should be the same size (this may be only half a large bun or half of a bagel)

Then you add fruits and veggies to the second and third quarters.

Come on, I know that half of you aren’t eating any fruit, and fully one quarter of you aren’t eating any veggies today. Give it up. It’s time to change. And this plate technique can help you.

Make sure you add vegetables and fruit to be the same size as your meat and grains. You are supposed to eat as many fruits and veggies as meat and grains combined.

There you have it a plate fit for a king. A fit king.

When ordering at a restaurant it can be difficult to have everything arrive all on one neat little divided plate. I doubt they stock those cute cartoon plates anyway. :-)

BUT you can order a salad for your first course, or vegetable appetizer. You many need to hunt through the choices since some foods are a bit awkward to eat with business associates. Look over the menu, find something. It’s a good idea to have your server put the sauce or dressing on the side.

Then when your dinner arrives, trim your meat to the appropriate size. And DON’T pick at the remainder. Just eat your right-sized portion and leave the rest.

Remember, the clean plate club has been disbanded!

Steve and I quickly realized that all the restaurants in Steamboat Springs served up enormous portions of food. We had to find a solution. And so, we divided and conquered.

Instead of dividing our plates we divided our order to conquer the overwhelming portion sizes. I began to order one main dish and then split it between the two of us. This works well when traveling with a companion. Alternatively, you can split the meal when it arrives and put half in a to-go box. Now your meal is right-sized and the cooking for tomorrow is done too!

I was able to enjoy the meal without that uncomfortable overstuffed feeling. I maintained my weight throughout the week. Splitting an entrée might be a bit awkward with a client. But it worked for me when traveling for leisure.

How do you handle the large portion sizes offered at restaurants?

Share your ideas in the comments below.

Get your FREE Resource Guide for Business Travelers with the tools I use every day to keep travelers safe and healthy.

What do Business Travelers Need to Know About Measles?

FeverIt’s been a tough day. Your presentation went well. Now you realize how exhausted you are as you melt into a seat at the airport pub and order a chicken sandwich. As usual, you begin to tap away at your phone catching up on emails. You just want to get on the flight and get home to your family when something catches your eye on your phone: A warning about a measles outbreak affecting all travelers at the airport.

Really? Do you need to worry about measles whenever you walk through a public space?

Yup, measles is the most contagious virus on the planet.

You can catch it just by walking through a place where someone with measles was, two hours ago.You don’t even need face-to-face contact with an infected person. Yikes.

But you only need to be concerned if your measles vaccine is not up to date. If you are properly immunized, relax you’re covered.

What’s the big deal about measles anyway?

Measles is rather nasty disease. That is why the vaccine was developed in the first place. Not only are you miserable, fevered, and have a pronounced rash, but 1 in 1000 people with measles go on to have a terrible brain infection and die.

That’s right, die, despite excellent medical care.

Collectively we have just forgotten how awful the disease is since we haven’t had a large-scale outbreak in the USA, until recently.

How did this happen?

In the late1990s a doctor in England faked medical data and abused developmentally challenged children for his own personal gain. He claimed that autism was related to the MMR vaccine. This has been rebuked by well-designed scientific investigation, but still he created doubt in the public’s mind.

This [false] doubt led to people being afraid to immunize their children. Which then led to a significant number of unimmunized people in Europe and the USA. This then led to the natural consequence of ongoing outbreaks in France, Spain, Wales and now the USA.

So now you, the busy business traveler, are exposed to hundreds of people when you travel, including those who might be infectious with measles. And you have no way of knowing who can make you sick.

Do you need a measles vaccine?

People without prior measles infection or 2 doses of vaccine need to get immunized. Now.

How can you protect yourself from measles?

The only way to protect yourself from this viral illness is vaccination. There are no medications to treat or prevent measles.

The first dose of MMR provides protection for 95% of people, and the second dose of vaccine provides protection for the remaining few. It takes two doses to provide reliable protection.

Who needs a measles vaccines?

  • Anyone born after 1957 who has never been vaccinated. There’s no time like the present to get caught up. You will need 2 doses of MMR at least 28 days apart.
  • Anyone who has received only 1 dose of MMR. If you graduated high school before 1990 you may not have received both doses of measles vaccine. Many adults in the USA are under-immunized because they received only 1 dose of measles vaccine as a child.
  • Anyone born between 1958 and 1967 . The original measles vaccine, which began in 1963 was different from the current MMR. It does not provide the right kind of protection. This is why we switched to the current 2-dose MMR vaccine.
  • Anyone who is not sure of his or her vaccine status. If you aren’t sure you have received both doses, go ahead and get protected. It is not harmful to get a third dose of MMR vaccine, but it could be very harmful to miss the second dose of vaccine.
  • Anyone 6 months or older planning to travel outside the USA who hasn’t received MMR vaccine.

Who shouldn’t get a measles vaccine?

  • Anyone born on or before 1957 is presumed to have measles immunity since all children in the USA got this infection. So there is no need to get vaccinated, you are already immune.
  • Anyone who has a problem with their immune system should check with their doctor. In some cases, you should not get the vaccine. If you can’t get the vaccine, be sure those around you do to protect you.
  • If someone in your household has an immune problem have them check with their doctor before getting your vaccine, just to be sure it is OK.
  • Surprisingly, most people with egg allergies can get the vaccine. If you have an allergy to eggs check with your doctor to see if you can get the MMR vaccine.
  • Anyone who is pregnant or planning on becoming pregnant in the next 28 days. Wait to get vaccinated after you deliver your baby
  • Anyone with a life-threatening allergy to neomycin.

A full list of do’s and don’ts and other information about measles vaccines is listed here.

For those with busy schedules, many pharmacies offer vaccines at convenient walk-in hours.

These are general guidelines. Always check with your own doctor to see if MMR vaccine is right for you.

Can I get a blood test to check on my vaccine status?

Yes a blood test is available to check for immunity. It is expensive and usually not covered by healthcare insurance. It’s primarily used for healthcare workers as part of pre-employment screening.

It’s actually easier and less expensive to get the measles vaccine. There is no harm in getting the vaccine if you are immune but didn’t know it. I mention the blood test for completeness, but it’s rarely used due to expense.

Bottom Line:

If you travel a lot, you will be exposed to measles since a significant numbers of people in Europe, Asia, UK and USA are not properly immunized.

Get yourself protected.

IF you don’t know your immunization status and were born after 1957 get a second dose of MMR. It’ll make you feel calmer, so that you can focus on your business and your life without worrying about outbreaks

Isn’t that what your really want anyway?


Get your FREE Resource Guide for Business Travelers with the tools I use every day to keep travelers safe and healthy.

What Can You Do to Avoid the Iceberg of Health and Safety Risks When Traveling Abroad for Business?


Travel vaccines. You don’t usually forget these when you go to a developing or exotic destinations.

They’re important; but they’re only the tip of the iceberg.

Lurking below the surface are a myriad of other travel-related health and safety risks, even in developed countries. If you don’t take precautions they can hurt you or your employees.

Here’s what I mean…

Several years ago I had the chance to watch icebergs form in a high mountain lake in Alberta, Canada.

I had hiked several hours through dry dusty chaparral to reach the crystal blue lake. At the crest in the trail a cool breeze swept me up and caught my attention. I could see white chunks of ice bobbing around in the water. Baby icebergs. Nothing like the one that sank the Titanic, but fascinating nonetheless.

But I was most surprised by what I heard: first a crack, like a shotgun in the distance. I didn’t see anything, but my senses tingled….something big was going to happen.

Then, a minute later, the deep boom. I felt as much as I heard it, rumbled through the valley as a block of ice the size of a car, broke off into the water.

It’s weird, but once the ice splashes into the lake you only see the very top, about the size of a driver’s seat. I knew the rest was there, I just couldn’t see it hiding below.

It’s that way with travel health too. What you need to know is more than you initially see.

Travel vaccines are just the tip. And the majority of what’s important is often hidden, out of view. It might even make you think that travel medicine is covered in routine healthcare.

But it’s simply not true.

Good travel medicine incorporates healthcare, safety, and security into one cohesive program {tweet}.

If you rely solely on routine healthcare to protect your employees you fail to consider how many different items need to come together to ensure safe and healthy travel. A good travel health program ensures you don’t miss the bulk of the problems below the waterline.

So why do only 10% of the 5.1 million Americans who travel abroad for business receive travel-related health care?

Organizations are either ill informed or short sighted. Some aren’t sure how to put an effective program in place. Others are hoping that nothing bad happens while their employees are traveling.

You need to know that as the employer you’re responsible for protecting your team the risks associated with business travel.


Plain and simple; it’s a workplace safety issue.

And it’s one that can be addressed with a comprehensive program.

Which issues should you address?

Well, to use the iceberg analogy we can start at the base and work:

At the base of is a commitment to overall health and wellness.

Many organizations implement a smorgasbord of health insurance, fitness, and stress-reduction programs. Currently a lot of research is being done to determine which programs are the most effective.

Oft overlooked, but truly foundational in a travel health program is sleep health.

Chronic poor sleep is associated with a wide variety of metabolic and productivity problems. For example, continuous nighttime sleep is essential for good weight control.

Jet lag contributes to sleep problems. Just switching as little as three time zones can cause you to function as poorly as if you’re intoxicated.

Your employees may be aware of their sleep problems but not quite sure how to fix them. Clearly, teaching them to solve those issues will help them be more successful at work.

The automobile presents the biggest safety risk to your traveling employees.

Different countries have different rules, lighting, and maintenance of their roads. Travel-related sleep deprivation and road signs in unfamiliar languages complicate these difficulties. Educational programs that focus on safe driving while abroad help your employees save lives.

Of course travel safety is more than automobile safety.  A comprehensive personal safety program is always a wise choice. The first step is to enroll in the Smart Traveler Enrollment Program (STEP) {link} and other programs by the US Dept of State. These are designed to keep travelers apprised of emerging security threats.

Health insurance carve outs are the ice caves in this model.

Many health insurance plans don’t cover out-of-country expenses like visiting the emergency room, medications, or require them to pay upfront and get reimbursed later.

If your employee suffers a heart attack or car accident they should be repatriated (brought home) for medical care. Air transport of ill patients can range from $10,000 to $30,000 and has to be paid up front.

A better alternative is a travel health insurance policy with coverage for evacuation. These are relatively inexpensive and a cost effective way to give you and your employees peace of mind while traveling. Your insurance agent can review the details with you.

Chronic health problems are like rocks in the iceberg.

They affect every layer of your program. When your team members travel with an underlying health problem they’ll feel as if they’re in vaguely familiar surroundings, quite comfortable until the cold wind of reality hits: a flare-up due to conditions at the destination. What will your employee do? It’s far better to address these issues with a pro-active treatment plan prior to departure.

Many travelers are unaware of the health consequences of travel, itself.

For example, did you know that blood clots can be caused by flights longer than four hours? And, if the flight is more than six hours, your employees’ risk rises substantially. Simple interventions can minimize these risks.

Near the water’s surface is education and prevention of locally acquired diseases.

Ebola has raised the world’s awareness that not all destinations are the same, and not all have the same healthcare infrastructure.

Surprisingly, travel to Europe, China, and South America have many unfamiliar problems that your employees need to address. Providing your team with destination specific advice is an essential part of a good travel medicine program.

Vaccines and medications form the tip of the iceberg.

As we near the top, specific concerns such as travel medications and vaccines pop above the surface for us to see. These are widely available from travel medicine specialists ({link ISTM} and local pharmacies.

To keep your employees safe, healthy and productive you’ll need a comprehensive travel medicine education program. One that addresses both obvious risks and the ones lurking below the waterline.

It’s worth repeating, travel medicine is a workplace safety issue.

When you provide your employees with the proper training, medications and vaccines to mitigate the hazards of travel you transform them into safe and healthy travelers; ones who understand the risks and why they should take certain precautions. And best of all, you help your employees become effective ambassadors for your organization.

Do you need help educating your employees about the health and safety risks of travel?

Give me a call, I’d be happy to discuss your specific needs.

Get your FREE Resource Guide for Business Travelers with the tools I use every day to keep travelers safe and healthy.

Why You Need a Workplace Health and Safety Plan for Your Traveling Employees.

Workplace Health and SafetyDanny was admitted to the ICU.

That simple statement is how I found out you could get sick on the job. I didn’t know Danny well,  he was my classmate in medical school. So when he came down with an infection, one that he caught from a patient, it changed my whole way of thinking. Before that, it hadn’t really crossed my mind that you could actually get sick while working.

Nowadays everybody knows this. You hear stories about nurses and doctors dying after contracting Ebola from their patients. Daily we see photos of healthcare workers in protective outfits being sprayed with chlorine after caring for patients. Despite all the protective suits, gloves, and masks, two nurses caught Ebola from a dying patient in Dallas, Texas.

The Ebola outbreak has been a wake-up call to the world. We’re far more connected and interconnected than we realize. Germs take advantage of that. And despite the ubiquitous information on the Internet, in newspapers, and on radio talk shows, we are struggling to contain and treat the Ebola outbreak.

Believe it or not, there are actually more dangerous viruses out there. Take the Marburg virus outbreak in Uganda, for example. And there are many more common health threats scattered throughout the world, even in Europe.

Not every health problem is as dramatic as Ebola or Marburg, but most people are unaware of the health risks of traveling, especially business travelers. They see ‘out there’ as the same as here. And that’s simply not true.

Different environments along with variable levels of governmental and healthcare services create unfamiliar health hazards in different parts of the world. We’re naïve to think that everywhere is the same, just because humans live there.

Travel Health is a workplace safety issue.

Just as you’d provide goggles, hard hats, and safety training for hazardous conditions on the job, you need to provide vaccines, medications, and safety training for your traveling employees. {tweet this}

Of course specifics will vary depending upon the destination, (just as the specifics of handling hazardous chemicals would vary depending upon the chemical being used), so it’s a good idea to know the geographical challenges of each area you send your staff.

You already know you’re responsible for providing a safe workplace and educating employees about anticipated safety risks. Here are some common ways companies protect their traveling employees:

  • Provide vaccines against diseases
  • Provide needed medications
  • Educate staff on preventative measures

Since vaccines can’t prevent all illnesses, preventative medication (like malaria pills) may need to be provided.

Also there are plenty of health risks for which there are no specific preventative medication or vaccines, only preventative measures. For example, using specialized insect repellents to ward off insect bites known to transmit diseases.

Often overlooked, is the effect of travel on employees with chronic health problems. Travelers to Beijing can expect to be exposed to irritating pollution. But, if you have asthma or heart problems, this noxious pollution can cause a serious flare of symptoms.

By addressing the effects of travel on underlying chronic health conditions you can provide the safest work environment possible. For that traveler with asthma; medications can be adjusted prior to departure to minimize the effects of pollution or other known triggers.

Since over 50% of Americans have a chronic health problem, that may or may not be known to their employer—it’s a good idea to have traveling employees review their destination with their healthcare provider. This will provide an optimum experience, one with minimal disruption to workflow from an illness.

Travel health is also a workplace productivity issue.

A key member of your staff can be waylaid by illness by failing to anticipate common problems. This then slows down the entire team and even undermines the reason for travel.

Bill was showing clients around in Asia. They were inspecting manufacturing plants to determine whether to invest in them or not. Suddenly GI distress set in and Bill had to leave the meetings. He actually got on the next plane home in order to see his own doctor.

Because Bill didn’t know how to avoid potentially infectious food he got into trouble. He also had no idea how to treat himself (many common illness can be treated while you’re on the road), and he didn’t know any local doctors. In addition, he potentially exposed everyone on the plane and his family to the infection.

But worst of all, he left his employer and his clients in a lurch and potentially soured a business relationship. All of which was preventable.

How much better it would have been if Bill had seen a travel specialist prior to departing. He could’ve avoided the wrong food, been able to self-treat, or see a local doctor.

It’s expensive to send your team abroad. Why risk wasting your investment with preventable health problems?

Education is part of the plan.

It was a great day when Danny (my medical school classmate) returned to work. He’d been gone for about three months with his hospitalization and subsequent therapies.

While he was gone we were left in the dark wondering what had happened, and whether it could this happen to us,. We also questioned if there anything that could’ve prevented his illness? Frankly we were distracted worrying about ourselves instead of focusing on our studies.

Danny’s ordeal underscored a weakness in our training program: we didn’t understand the health risks of our job or what we could do to minimize the chance we could get sick.

You may have overlooked this in your training programs too; there’s far more to workplace safety than OSHA compliance. Giving your employees the information and tools needed to stay healthy on the job helps them stay focused on the task at hand instead of wasting time and effort worrying about their personal safety.

Why not embark on an education program for your traveling employees?

You can hold workshops or seminars to help your team understand why traveling is a big deal and how to stay healthy when on the road.

Once team members understand how their health interacts with travel-related problems, they can develop proactive plans to stay healthy and productive while on the road.

Your organization can also use webinars and online courses to provide core knowledge and share timely updates with your staff. If your team is spread by geography and time zone, on-demand mobile friendly online courses are a popular option; they allow folks to learn important information at times and places of their choosing.

At TravelReadyMD we help organizations who want their employees to feel better, stay healthy, and get more out of the workday when they travel. We’re happy to help you assess your educational needs and develop tailored programs. CONTACT US  to see how we can help your organization.

Why Your Brain Tells You to Worry About Ebola

And Which Virus You Really Should Worry About.

Brain Worry

Alexa came in a few days ago with classic symptoms: first the headache, followed by a fever of 102, and then muscle aches; she felt terrible. In fact, it was the worst she’s felt in her life.

So with all that’s in the news lately she couldn’t help but ask,

“Could this be… Ebola?”

And so the questioning begins. “I have a trip to New York City next week, is it safe to fly? Is it safe to go out in public?”

All the while I was thinking in my head,

“Are you kidding me?? Of course it’s not Ebola. You haven’t been to West Africa, no one you know has been to West Africa. In fact, you haven’t even left the suburbs of Pittsburgh! Of course it’s NOT Ebola….Don’t you know we’re having an outbreak of the flu. That’s what you have! And why didn’t you get your flu shot??”

But of course, I didn’t say that, it wouldn’t have helped.

I am really frustrated that you, my patients, are spending a lot of time worrying about rare diseases, all the while missing opportunities to protect yourselves from common viral illnesses. Especially ones that can kill you.

Yes, KILL you.

But it’s really not your fault. Your brain is miscalculating your odds of impending doom.

It’s so hard to communicate real risk vs. perceived risk. What does that mean anyway?

Our brains are hard-wired to pay attention to new things and to be cautious about things we don’t know much about. Usually this is a good idea, since unfamiliar things can hurt us, so it’s best to stay on your toes.

However, this increased attention to unfamiliar threats can also be a problem. We can focus too much attention on something new, but rare, and forget to worry about what really matters–things that are common and dangerous.

You’ll often extrapolate what you know from your own experiences to the unknown but make incorrect assumptions about that unknown situation.

That is, we make a poor estimate of the true risk of the new/unknown thing based on what’s happened in the past. This causes us to over-estimate or under-estimate the likelihood that the new problem will harm us.

That’s exactly what is happening with Ebola and the relentless media attention it’s getting.

We’re spending a lot of time worrying about something that isn’t a real threat to people living in the USA, and not enough time worrying about things that do affect our health and safety.

We humans are funny. We can even understand that we’re at risk for a bad outcome but won’t actually do anything about it. How we perceive dangers and what we want done about the dangers is an area of active research

I see this on a daily basis with influenza.

  • When offered the flu vaccine most people accept either the injection or inhaled variety. However, quite a few choose not to get protected, even though it’s hands down the best value in medicine. For around $25 you can protect yourself from a virus that’s readily spread through the air, kills perfectly healthy people  and is easily prevented by annual immunization.
  • Infection with influenza is quite common and deadly. I know this all too well. A young, healthy woman in our town died last year from influenza. Flu infects between 5-20% of the population and kills between 3,000 and 49,000 people each year in the USA. In fact 55 perfectly healthy children died from influenza last season.
  • So prevention would help a lot of people and save a lot of lives.
  • Compare Influenza to Ebola and it becomes clear our real risk from death from a viral infection in the USA is from influenza. To date, nine people have been infected with Ebola, but only two contracted the illness inside the USA (while caring for a patient sick with Ebola). One person has died of Ebola he contracted in Liberia.

Why are we so worried about Ebola? By the numbers, we should be worrying about Influenza, but our hard wiring tells us to pay attention to Ebola. It’s weird, but that’s the way our brains works.

Now it’s time to get a grip, overcome our basic instincts and conduct our lives as usual.

That still leaves our brains with a big question: What should we do about Ebola?

  • Learn the facts
  • Feel free to travel in the USA since you cannot catch Ebola through casual contact.
  • Stop calling for closing the borders, that’s not how you stop the spread of germs.
  • Provide substantial assistance to the three countries most severely affected. (That is how you prevent the spread of germs.)
  • Let the experts in health and safety at the CDC and WHO do their job. They ‘re the best in the world at protecting us from infections. Don’t second-guess them just because your brain is worried about something you don’t understand.

Evaluate your real risk of Ebola… slim to none if you live in the USA.

If you want to worry about a viral illness, focus on influenza, and get protected with a vaccine. It’s easy; immunizations are effective and widely available.


I’d love to hear your thoughts on the matter. Leave a comment below:

Do you need shots for World Cup Soccer in Brazil?


You are going to have a great time.  Let’s make sure you are also safe and healthy while you are having fun.

The first thing to do is to meet with a travel health specialist.

You may need shots to stay healthy at in Brazil. Your travel specialist will make sure your routine vaccines are up to date. Vaccine preventable illness is everywhere, but the variety increases when people gather from all over the world.  Tetanus, Pertussis, Influenza, and Measles are just a few on the list. Travel related vaccines to consider include Typhoid Fever and perhaps the most important one, Yellow Fever.

Your provider will also discuss malaria prevention, with risks varying greatly throughout the country. You may need preventive medications to be started before you leave home, especially if you are lucky enough to score tickets to the venue in Manaus. Insect precautions are discussed later in this article.

Food and water precautions and medication for treatment of traveler’s diarrhea are key. Food should be served piping hot. Eat only fresh fruits that you peeled yourself and vegetables which are cooked.  Dairy should be pasteurized. Bottled water, carbonated beverages, hot coffee and tea should be fine, but avoid tap water and ice cubes made with tap water.

What about the time zone difference?

Strategically using natural daylight and sleep aids can help with jet lag. Do your best to stay rested, but most of all, check your tickets and watch your game times because there are three time zones in Brazil!

I mentioned Yellow Fever vaccination above. Here is the scoop:

Yellow Fever is caused by a virus transmitted by a mosquito. It is bad.

Some cases are actually asymptomatic, but some are quickly and completely fatal.  Flulike symptoms begin 3-6 days after the bite and either resolve or progress toward abdominal pain, vomiting, hemorrhage, internal organ involvement, and possibly death.

It is called “Yellow Fever” because you literally turn yellow as the liver is damaged.

This is a big concern for travelers to certain parts of Brazil, especially World Cup visitors to the venue cities of Brasilia, Belo Horizonte, Porto Alegre, Cuiabá, and Manaus. Visitors to other World Cup venue cities may be OK without the vaccine, but expanded itineraries,   may change that.  A travel health specialist can help you research this as well as special precautions around receiving the Yellow Fever shot.

How to Prevent Insect Bites and the diseases they carry:

Here is the good news: If you aren’t bitten by an infected mosquito in the first place you won’t catch Yellow Fever. Or any other awful disease transmitted by mosquitoes, such as Dengue, Chikungunya, and Malaria.

So prevent bites. Long sleeved shirts and long pants, clothes treated with Permethrin, and for exposed skin, insect repellant containing DEET or Picardin make a huge difference. Layer repellant lotions and sprays on top of sunscreen, not underneath.

Personal safety while in large crowds.

“I should be OK once I am at the stadium. There is safety in numbers, right? “ Not these numbers!

Three million people will gather from all over the world to celebrate soccer. The thrill of attending the World Cup is being part of a cheering crowd. Much of the risk to your health and safety is found right there in that crowd.

Crime can be petty or violent. Leave your valuables in the hotel safe, or better yet, at home. Do not wear obvious symbols of wealth: expensive watches and jewelry. Protect your wallet and money. Don’t even think about using your pockets.

Sadly, we have all seen reports in the media of occasional riots and stampedes at such gatherings. Large groups of people who have lost their personal space (i.e, crowds) are naturally more inclined toward hostility. Combine this dynamic with alcohol, a favorite team’s loss, or someone saying something stupid. Add a few authentic hoodlums, throw in some panic, and you have the recipe for a riotous stampeding mob.  What can you do about that?

Be prepared. Stay really calm. Have a fully charged cell phone and a plan to reconnect with your group should you become separated. Wear shoes that make sense. Yes, sensible shoes! You will need good  balance and comfort.  You don’t want to be the one to trip and cause the pile up.

Arrive early and locate the First Aid station, exits, alternate exits, and shelter should the weather turn.

If you see a group of people gathering suddenly, resist the urge to move in for a good view. Move away. This could be a fight breaking out or a crime scene.

When the event ends, there will be a sudden exodus of people leaving the stadium. Most will be lovely. Some will be drunk. Some will be upset. Be careful here.

Moving crowds are like moving rivers, with the flow fastest in the center of the stream.  Stay toward the sides where the flow is slower and keep an eye out for potential exits or shelters should the crowd turn bad.  Never swim upstream.  Never stop suddenly.

If you want out, stay calm. Continue to move with the crowd as you slowly move laterally.

Also, however you plan to celebrate your team’s victory, no stage diving, crowd surfing, moshing, or Wall of Death. If you don’t know what these are, ask a teenager.

Know the weather forecast and dress in appropriate layers.  Some bring earplugs to use should the noise level become uncomfortable.

A few random tips:

Avoid natural bodies of fresh water in some areas of Brazil. There is a little larva, called Schistosomiasis, which can quietly and quickly pierce your skin and cause harm to your internal organs.

But if you choose to swim in salt water, check with the local authorities on the risks of certain potent jelly fish, currents, and other marine hazards.

Your best bet may be the chlorinated hotel pool!

And in case you are in serious trouble and need a medical evacuation home, your travel health insurance policy, wisely purchased before leaving home, will save the day.

Have a safe trip. Have a wonderful time! Come back healthy, but if you do get sick after returning home it is critical to tell your doctor about your itinerary.  Treatable travel related health issues, especially malaria, can surface long after you have unpacked.


Are you headed to the games? Which team do you cheer for? What worries you the most about your trip? Share your thoughts in the comments below:

Vaccines for Business Travel: Which Ones do You Need?

Booster Vaccines for TravelersWhy some business travelers get their vaccines before they know where they are going.

Jim was in the office asking questions, ” Are you kidding me?”

“Nope, how long have I known you Jim? If your new job promotion includes traveling abroad you need to get some vaccines. I suggest you start now, even before you know your assignments.”

“That’s crazy, why would I get my vaccines before I know exactly where I will be assigned to go? Shouldn’t I wait and see where I go?”

I knew what he was thinking. I’d heard it before. Truth is, it’s a rather good idea to start vaccines before you know where you will be going. Many adults are surprised to learn their children are far better protected with immunizations than they are.

“Most business travelers leave quickly, often with less than 2 weeks notice. You hear a rumor that you may be headed to Sao Paulo, Brazil… but your boss is not sure. You wait. Finally the OK comes and the corporate travel office sends you the tickets a week before departure.
Oops, now there is not enough time to get the vaccines you might need. You see, most vaccines take about 2-4 weeks to become fully protective. This is where the travel department is out of synch with modern medical practice.”

Like most of the business travelers I see, Jim asked for a few minutes to think things over.

When should international business travelers get their vaccines?

This where Jim had it right. He is following the CDC guidelines by visiting me, his travel medicine specialist, at least 4-6 weeks in advance.

This recommendation allows you to receive the proper immunizations and be fully protected before you leave. If you know you will be traveling somewhere, but the plans are not finalized yet you can at least get the basic shots, and then add any destination specific travel vaccines as needed.

If you go to your travel doctor with less than 4 weeks prior to travel, you can still get caught up on your adult vaccines at your visit and discuss strategies for prevention of illness. However, this does leave you in the precarious position of not being as well protected, as you would be if you visited 4 weeks or more prior to departure.

Many people are not aware that you are likely to need a few booster shots since it takes up to 6 months to complete both of the hepatitis series.

Which vaccines do business travelers really need?

You will need to check with your doctor about recommendations specific to you. Most adults are a little behind on their routine immunizations.

You may need any or all of the following common adult vaccines:

  • Tdap has protection for both tetanus and whooping cough.
  • Pneumonia is recommended for people who smoke, are over age 65, or have other medical conditions such as diabetes and asthma.
  • MMR, many adults need a booster. With all the terrible outbreaks in Europe, it would be wise to be protected.
  • Flu, this annual scourge ruins more trips than any other preventable infection.
  • Hepatitis B, recommend for people with diabetes, for frequent travelers and people with more than one sexual partner per year.
  • Hepatitis A, recommended for almost all travelers.

All of the above vaccines are routine vaccines nowadays for children living in the USA; they just weren’t available when you were growing up.

If you know you are traveling to a resource poor area, even if you are staying at a Western-style hotel, you should consider adding the Typhoid vaccine.

There are other vaccines for specific destinations under specific conditions such as Japanese encephalitis, meningitis, rabies, etc. It’s best to discuss these with a travel medicine specialist before choosing them.

What are the bare minimum vaccines needed?

The bare minimum vaccines recommended by the CDC are listed above. Since everyone has different underlying health problems, you should check with your own health care practitioner for advice specific to you.

Can travelers accidentally transmit diseases to your family?

Yes, and this is probably the most compelling reason to get protected with vaccines. Often you become contagious 2 days prior to coming down with symptoms. So, not only will you be sick if you bring home these common ailments, but you will transmit them to your loved ones too. You will feel terrible if you spread these diseases to a friend or relative. Fortunately, your vaccinations will not make your healthy family members sick.

What about last minute change in plans?

Travel is fraught with unplanned changes. A sudden change in destination should be discussed with your doctor since you may need more preventative care. The vaccines listed above are routine adult vaccines, ones you need anyway, so you don’t need to worry if your plans are cancelled. As a bonus, you are protected for future trips.

Crazy as it seems, getting vaccinated prior to knowing where you will be traveling is a good idea.

In fact, this is exactly what the military does for their troops. They provide a backbone of basic vaccines for everyone who is likely to be deployed. Each division then gets specific shots depending upon the area of the world where they may be assigned and their specific duties there. This way, the lack of medical protection does not need to factor into the strategic goals of the unit.

Use military tactics to prepare your workforce

Many human resources departments are adopting this strategy too. This works well since most adults are behind on their standard vaccines–this gives an opportunity to catch up. Additionally, having the Hepatitis A & B vaccines along with the typhoid vaccine makes you worldwide ready and ready to deploy on short notice for most destinations.

Follow Up

Jim decided to get started catching up on his vaccines. With about one week notice he was sent to Shanghai and Beijing. He felt confident he was protected as he headed out to meet new business associates. I am looking forward to hear how things are going when he comes back in for his hepatitis booster shots.


Share your thoughts in the comments below. How do you choose vaccines for business travel? Are you current with your adult vaccines?



Tips for International Travel With Children




The Girl Scouts entered the border crossing office like soldiers: silent, single file, and in full uniform.

As the agent inspected the “troops” their leader   presented The Binder. (The documentation needed to travel internationally  with an entire Girl Scout Troop is measured in pounds, not pages.)

Rainbow Bridge was just beyond the door….

Three months’ worth of preparation lay open in front of him. A few questions and then,  “Welcome to Canada!”

Travelling internationally with children is a joy, however  it requires advanced planning and research. Passports, prescriptions, insurance cards? Custody issues? Children with special needs?

The answer is the same: “There is a form for that.”

How to Get a Passport for a Child

Start with obtaining the passport. Your child needs a passport to travel internationally and getting one can take  up to 8 weeks, maybe longer.

For a child under 16 years of age you must apply in person and you will need to take the following:

  1.  THE CHILD.
  2.  Money: up to $120 depending….
  3.  Evidence of U.S. Citizenship: for example, a certified birth certificate
  4.  Evidence of Parental Relationship: usually on the birth certificate
  5.  Photo ID for the parents: driver’s license, passport, etc.
  6.  Parental Consent: both parents should be there if possible
  7.  Passport photo of the child
  8. The application itself, downloadable

A minor  of  16 or 17 years of age can apply alone, but parental presence is recommended to demonstrate “consent to issue” the passport.

Taking a passport photo of a baby sounds harder than it is. You can do this for free at home. Using a digital camera, wait for the time of day when your baby is at her best. Place her on a white sheet on the carpet, or prop her in a car seat draped with a white sheet.

Need help with with sizing and cropping the photo as well as much more information  about applying for passports? Detailed advice is available here.

What if Dad isn’t travelling with us? What if we share custody? What if it isn’t my child?

You will need a copy of the legal custody or guardianship document, and/or notarized consent from the non-travelling parent(s).

Health Insurance for People Travleing Abroad

Young kids get sick a lot.  Motor vehicle accidents are common. It can cost $50,000 or more for an international air ambulance evacuation home.

Contact your health insurance provider for the limitations of your plan. What does “out of network” really mean? Bring along  your child’s insurance card and contact info for authorization and billing.

Also consider obtaining International Travel Medical Insurance that includes Emergency Evacuation Assistance. Your travel medicine specialist can direct you to several plans.

How to Bring Medications Along

Travelling with children often means travelling with  medications.  Someone, it seems, is always on the pink bubble gum medicine. Holiday travel may be a bad time for a  holiday from ADHD meds. You want your child as well as the rest of family to share the most meaningful experience possible.

Be careful here. Prescriptions should be in their original labeled containers. Consider bringing along a recent, dated letter from the pediatrician on her/his letterhead stating the name, dose, and diagnosis for which the medication was prescribed. A copy of the original prescription is also helpful.

Be sure your child’s meds are travel-legal! The consulate of your destination can help you determine what meds you can take in with you and which require alternatives or an in-country prescriber. Certain pain meds and ADHD meds, for example, may be banned at entry. Delay, embarrassment, stress, incarceration are possible outcomes if you get this wrong.

Traveling With Children Who Have Speical Needs

What if your child has epilepsy and has a seizure after a visit to the Butterfly Park in Singapore?  What if he has asthma and isn’t doing well after hiking in the Black Forest? What if she has had a kidney transplant and develops a high fever as the cruise ship docks in Grand Cayman? First responders and emergency department caregivers will want a lot of information from you, fast!

Travel with the “Emergency Information Form for Children with Special Health Care Needs.” Your child’s doctors have access to this document designed for children with particular medical challenges. You and your child’s doctors(s) will complete this together. It is invaluable when treating a child with special health care needs in an urgent situation.

You may want to scan your child’s travel documents for access as a backup plan, but always have the original paper documents with you. Remember, paper never “crashes.”

Do you have tips for traveling with children? Share them in the comments below:
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How Do You Find a Doctor When You Are Out of Town?

Alta Clinic 

We gleefully fly through the gates marking the edge of the trail off into the off-piste snow.

You don’t get too many days like this; no sense wasting it on groomed trails. Ann, my 20 year old daughter, skillfully shoots down the mountain, but something goes wrong. She tumbles head over heels before crumpling into a pile on the slope.

Terror & guilt. My baby…is she hurt? Is she hurt bad?

Slowly, Ann starts moving.

Relief, her ski has come off, preventing a knee injuy. But she can’t get the ski back on because her hand is too painful.

Carefully, my brother helps her put the ski back on after muttering something about the ski robbing her of a powder run. He is relentless like that…in his pursuit of powder!

It is a storm rider day, a day where snow is falling fast, a day where skiers speak in hushed reverent voices…afraid to let their excitement show. My brother’s children have abandoned him at lunch, something about being too tired and cold. And so he is on a mission to make sure we don’t miss this sacred moment of skiing.

We start to ski again but her hand is too tender; she can’t hold her pole. And that’s when I begin to suspect that she has injured herself.

At the bottom of the run, Ann pulls off her glove so that I can examine it. Swollen, tender, and black and blue…it is obvious to the untrained eye that her finger is broken.

We are away from home, in Utah. What should we do?

The café gives us a bag of ice for the hand while I scrounge some ibuprofen from deep inside my jacket to give to her. Then we pull out our phones to locate a doctor. This is the age of Google after all, so it seems logical to check the reviews of the ERs in town.

Thank goodness for smart phones. Instantly you have the world at your fingertips, which is especially helpful when you are out of town, away from your local network.

How Can You Find a Doctor When You Are Out of Town?

  • Check with your insurance company online. It sounds obvious, but it makes a big difference in how things get paid. Some plans have preferred providers, some have preferred types of care (Urgent Care vs. ER). In Ann’s case, her insurance wanted her to start at an Urgent Care and move up to an ER if needed.
  • Online reviews can be hit or miss. Sites like Healthgrades keep data about training, specialization, etc.  Be careful, there are too few reviews at this point in time to rely on them. Your insurance plan may have reviews of in-network providers. Ann’s insurance had extensive online reviews…so she was able to find a good specialist for follow up that way.
  • Ask a local, they usually know what isn’t written down in the reviews. Where do they go when they are injured? Of course your information is only as reliable as your source, but people are generally very helpful and quite knowledgeable. You can always double-check the facts with another person or Google search.
  •  Can’t find anyone? Go to the ER at the local University.
  •  If you are traveling out of the country the International Society of Travel Medicine (ISTM) and the International Association for Medical Assistance to Travelers (IAMAT) have directories of English-speaking doctors. You will need to check their credentials and specialization to see if they meet your needs, but generally speaking they are a great place to start.

Ask a Local

That’s when we notice Moqui, the ski patrolman enjoying a cup of coffee at the café. Moqui encourages us to use the resort doctor. He tells us the doctor in the clinic takes care of this type of injury all day long. And they do indeed have an X-Ray machine and the ability to apply splints. Exactly what Ann needed. He says Ann should definitely have it taken care of today. He pulls off his glove to reveal weathered hands with a large lump on top– the result of not getting immediate medical care for an injury, or so he says. Some quick directions and we were off.

“The Hand is Here, call Bob”

The clerk calls out, “The hand is here, call Bob” as Ann walks into the small clinic with her entourage (us). The bright, well appointed clinic has a pleasant waiting area stocked with an ample supply of Powder Magazine, a magazine devoted to photos of impossible ski stunts which usually land you in a clinic of this sort.

She is greeted by a friendly woman who explains the process, including how to get access to her medical record online when she gets home and the fact that they don’t accept insurance. Ann will need to submit the paperwork (given at the end) to her insurance company for reimbursement. Now this is okay in the U.S.A., but if you are abroad you will want to purchase a very affordable travel health insurance policy. Most health insurance plans are not accepted abroad. It can be rather expensive to pay your medical bills upfront, especially if you will require hospitalization. If Ann had needed more than an Urgent Care visit, we would have driven to the local ER, which was only an hour or so away.

The clinic is staffed by avid skiers who sneak in a few runs when the clinic is slow. In fact, the doctor still has his ski pants on while he was busy helping a 20-something with his busted knee and an older man with some sort of shoulder injury. This instantly makes us feel comfortable- people with the right expertise who also share our passions.

Dr. Ken

The nurses move Ann back to the treatment area, make her comfortable, and explain the process to her. First the doctor will see her, then an X-ray will be taken, and afterwards any needed treatment will be given. Doctor Ken Libre of the Alta Medical Clinic is right out of a television program: tall, kind, thoughtful, he instantly wins us over. A quick check on Healthgrades reveals he is very well trained in Family Medicine, and rather smart too since he graduated from Dartmouth Medical School.

He examines her and orders an X-ray. That is when we noticed the X-ray tech, Bob. He suddenly appears still wearing his ski boots, wet with fresh snow in the buckles.

This is definitely a clinic for skiers staffed by skiers.

Dr. Ken reviews the X-ray, examines her hands, takes some photos, and contacts a hand specialist. It is comforting as a parent to realize that this clinic has access to all sorts of specialists who can provide a virtual consult via a ‘smart’ phone whenever it is needed. This removes any doubt I might have about where to take an injured family member.

After some discussion, Dr. Ken recommends straightening the finger in the clinic, placing a splint, and having Ann follow up with a hand specialist in her hometown. She leaves with a bandaged hand, easy to understand instructions, and copies of her X-rays for the specialist.


The next day we see Moqui on his snow machine off to help another injured skier. He slows down to ask Ann how things went, and is pleased to see she had a proper splint applied and will see a hand specialist upon her return home in a few days. Several weeks later, her hand works well.  Which is very important, since she works with computers for a living, and her fingers are straight and beautiful…no lasting lump.

Hand in splint

I hope you never need to find a doctor when traveling. However, just in case, as part of our travel consultation at TravelReadyMD we help identify doctors at your destination who can see you in the event you become ill while traveling.

Have you ever become sick or injured while traveling? How did you find a doctor? Share your story in the comment section below.

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Review of Grass Roots Injury Prevention: A Guide for Field Workers

GRIP Guide Samarakkody, D., Elizabeth Davis, and Rod McClure. Grass Roots Injury Prevention: A Guide for Field Workers. Rugby, UK: Practical Action Publishing, 2013. Print.

This book resonated with me immediately. I wish I had read it about 5 years ago. That is when I took my children, in their early teens at the time, to volunteer at a site where a home was being restored for a family in need.

Home Building: Site Dangers

We joined the team when siding was being hung. My kids and I cut pieces of vinyl siding  to specs so that the pieces would  fit neatly around the windows. Then we handed these cut pieces of siding out the nonexistent windows to men perched high on ladders.

So far so good.

There was a designated footpath from the parking lot across the “lawn” and a long plank  which crossed the nonexistent front porch and up to  front door. All nails and shrapnel were to be kept off this designated route. All workers were to be kept on this designated route….. Sure.

Someone started to sweep up 80 year old house dust. And as the sun set it got colder. Of course it did: no furnace yet and no  actual windows.

Soon a nice young man offered to teach my daughter how to use a hand held power saw to cut wood and she was ready to learn.

Afterwards, we thanked them for including us and made our way down the special path to our car, proudly clutching our official worksite t-shirts.

It doesn’t surprise me that, years later, my daughter would become an engineering student at MIT. (They have a whole shop filled with power saws there.) What does surprise me was that no one went to the emergency room that night with a nail in their foot, wheezing, hypothermia, or a laceration. 

When I was asked to review this book, I recalled the day we spent at the homesite and completely  understood its relevance, both in the developing world, and maybe even in Western Pennsylvania.

This book is just what is needed.

The Science of Injury Prevention

Diana Samarakkody has expertise in public health and epidemiology, devoting herself to injury prevention and management. She is a Post-Doctoral Fellow at Monash University Accident Research Centre in Australia where she teaches undergraduate and postgraduate medical students. She serves as the National Program Manager for Injury Prevention and Control at the Ministry of Health in Sri Lanka.

This book is a collaboration. Dr. Samarakkody, the coauthors, and  contributors are all equally worthy of credit for their life’s work and writing in the causes of health, safety, and promotion of peace.

A Practical Guide for Field Workers

Take one look at the cover and you already understand what this book is about.  And you think, “At last!”  Susil Jayashantha Perera’s  spot-on art  depicts a woman in a medical uniform, quite literally “in the field,” sharing printed information with lay people, engaging a local woman in discussion as others gather.

Hint: I don’t see a hospital in the background. This book is a manual for this health worker and all who follow in her footsteps. Its illustrations complement and enhance the text nicely.

Academic works on the science and principles of injury prevention abound …thankfully! This book, also known as the “GRIP Guide”, will serve as the critical, final link in the chain between all that scientific knowledge and “field workers who want to make their communities safer.”

It starts with a brief, motivating discussion:  “Everyone in a community is affected when someone dies or is disabled by an injury.” Lower- and middle-income countries account for 90 percent of global deaths due to injury.

Yes, a family can lose its breadwinner, but  this book also reveals a sensitive awareness of the nonmonetary impacts of injury. It spans the concrete, such as pain and bleeding, and  the profound: “Loss of dreams and expectations of marriage and children,” and loss to the “social and cultural life of the community.”

It empowers the field worker, including those with no formal training in medicine, public health, epidemiology, or public speaking, to tackle this challenge onsite. There are no big lectures to give or manuals to hand out. Instead, the reader learns step by step how to empower communities to face their own challenges and to sustain their own work.

How to Begin an Injury Prevention Program

It begins with the basics of forming a group, brainstorming, using case studies as teaching tools, mapping the community with respect to potential risk, and moves on to creating calendars and charts, leading field visits, and addressing ethical issues.

It slows down on the exact definition of injury and a discussion of specific types of energy but then moves on to vivid  examples of energy sources that can cause harm: stampeding animals, harvesting knives, landmines, chemical fumes, bodies of water….

Next come modules, which can be used in sequence, or as freestanding lessons addressing specific types of injury, for example, “Burns” and, “Transport Injuries.” Along the way case studies are used featuring a fictitious worker, “Dula,” and her fictitious village. These realistic stories, along with the accompanying illustrations will help the worker hold the attention of locals and teach them  what they need to know.

Perhaps the wisest advice given is to be sure, whenever possible, to enlist the involvement of international agencies, local public health staff, the school principal, religious leaders, elders, etc., in addition to an intentionally diverse group of residents.

I have to admit that on first reading, I felt the book was elementary.  Then I read it again and understood it is exactly what it is designed to be and exactly what has been missing. Grass Roots Injury Prevention trains the field worker, from scratch if needed, using an elegantly appropriate writing style and illustrations that enhance.

With this guide, the field worker will enable communities to get injury prevention right and sustain it.

In summary, this book will save lives.


Note: Practical Action Publishing deserves mention here as it is a company committed to “supporting international development through the dissemination of knowledge.”  This company prints books and peer reviewed journals. It collaborates with over 70  groups including the World Health Organization and United Nations Children’s Fund, and offers a book voucher and donation system. This system provides published resources for those who need them most, but may not have the financial or logistical means to obtain them.


Have you experienced a preventible injury? Share your experiences or thoughts about Grass Roots Injury Prevention in the comments below.