Problems That Occur in Transit
Several conditions are common even among healthy people while in transit.
Motion Sickness
Motion sickness during air, sea, rail, bus, or car travel occurs when the brain receives conflicting signals about movement (see Section 6, Chapter 80). Motion sickness is often triggered by turbulence and vibration and made worse by warmth, anxiety, hunger, or overeating. The main symptoms are stomach upset, nausea, vomiting, sweating, and dizziness.
Motion sickness can be minimized before and during travel by moderating intake of food, fluids, and alcohol. Fixing the eyes on a stationary object or on the horizon can help, as can lying down and keeping the eyes closed. Other measures include choosing a seat where motion is felt least (for example, in the center of an airplane, over the wing), refraining from reading, and sitting by an open window or an air vent if possible. A cabin in the middle of a ship close to water level may reduce motion sickness in some people. A scopolamine patch (which requires a prescription) or antihistamines are often useful, especially if taken before travel. These drugs often cause drowsiness, light-headedness, and dry mouth and can result in confusion, falls, and other problems in older people.
Blood Clots
Blood clots can occur when people sit for long periods during air, rail, bus, or car travel. Blood clots generally affect older people; people who are overweight, smoke, have varicose veins, or are taking estrogen; pregnant women; people who have recently undergone surgery or who have had blood clots previously; and people who have been inactive or immobile. Blood clots form in leg or pelvic veins (deep vein thrombosis (see Section 3, Chapter 36)) and occasionally dislodge and travel to the lungs (pulmonary emboli (see Section 4, Chapter 46)). Some blood clots in the legs do not cause symptoms, whereas others cause cramping, swelling, and color changes of the calves and feet. Pulmonary emboli are much more serious than leg blood clots; people may first develop a sensation of not feeling well, followed by shortness of breath, chest pain, or fainting. Pulmonary emboli are sometimes fatal.
Blood clots can be prevented by changing position, straightening and moving the legs frequently while seated, and getting up to walk and stretch every 1 to 2 hours. Prolonged leg crossing may decrease leg circulation and should be avoided. Drinking fluids; avoiding smoking, caffeine, and alcohol; and refraining from wearing stockings, pantyhose, or pants that have constrictive bands at the top of the calves or thighs also help. Elastic support stockings improve circulation in the legs and may help as well.
Ear and Sinus Pressure
Ear and sinus pressure while flying is the result of changes in air pressure (cabin pressure). Normally, as an airplane takes off, cabin pressure decreases, and small pockets of air trapped in the sinuses and middle ear expand, leading to ear pressure, ear "popping," and mild sinus pressure or discomfort. As an airplane descends, cabin pressure increases, and similar symptoms occur. These mild sensations usually disappear as air pressure in the sinuses and ears equalizes with cabin pressure.
Swallowing frequently or yawning during takeoff and descent helps equalize pressure. These actions are normally sufficient to relieve minor ear and sinus discomfort. With allergies, sinus problems, and head colds, however, the passages that connect the ears and sinuses to the nose and mouth become inflamed and obstructed by mucus, which prevents air pressure from equalizing normally. People with these problems may experience significant discomfort and benefit from taking decongestants before flying or by blowing hard against a closed mouth and pinched nostrils to equalize air pressure. People with severe nasal and sinus congestion, whatever the cause, should consider postponing air travel.
Children are particularly susceptible to the pain of unequal air pressure. They should chew gum, suck hard candy, or be given something to drink during takeoff and descent to encourage swallowing. Babies can be breastfed or given a bottle or pacifier. In general, infants may fly safely after the age of 7 days.
Sleep Disturbance
Sleep disturbance (jet lag) is common with air travel across more than three time zones. Sleep disturbance does not occur with sea, rail, or car travel because travelers have time to adjust to time zone changes. The most obvious symptom is fatigue on arrival; other symptoms include irritability, difficulty sleeping (insomnia), headache, and difficulty concentrating. Jet lag can be minimized by adjusting sleep and wake times 1 or 2 days before departure to coincide with those of the destination time zone. In flight, a person should drink plenty of fluids and avoid smoking, caffeine, and excessive alcohol. Some people also benefit from supplements of melatonin, a sleep-inducing hormone normally produced by the body during periods of darkness. Melatonin induces sleep without a "hangover" effect when taken about 1 hour before regularly scheduled bedtime. Melatonin is more effective when traveling east, because the duration of daylight during travel is less, and nightfall arrives earlier. Other short-acting sedatives may also be helpful but may cause side effects, such as daytime drowsiness, amnesia, and nighttime insomnia. Long-acting sedatives, such as diazepam, can also cause confusion and falls in older people and should be avoided. On arrival, travelers should minimize napping, maximize exposure to sunlight, and remain physically active until evening.
Dehydration
Dehydration while flying is common because of the low humidity in airplanes. Dehydration tends to affect older people and people with certain medical conditions, such as diabetes and disorders requiring treatment with diuretic drugs. The main symptoms are light-headedness, drowsiness, confusion, and, occasionally, fainting. Dehydration can also cause dry skin. Dehydration can be prevented by drinking fluids and by avoiding alcohol and caffeine. Dry skin can be treated with moisturizers.
Spread of Infection
Spread of infection on airplanes and cruise ships often receives media attention but is relatively uncommon. Concern is greatest for influenza, viral diarrhea, and bacterial meningitis. Travelers can minimize their risk of influenza by making sure they have received the most current influenza vaccine. They can minimize their risk of diarrhea by washing their hands frequently. There is no reliable way to prevent bacterial meningitis. Some cruise ships offer antibiotics to passengers who have been in close contact with passengers who have these infections.
Minor Injuries
Minor injuries are common. Unaccustomed lifting of heavy luggage is a common cause of shoulder injuries. Luggage falling out of overhead storage bins can cause other significant injuries. During ship travel, injuries can be prevented by wearing shoes that provide good traction on wet surfaces; using handrails and removing sunglasses before entering ship stairwells; and remaining alert in unfamiliar surroundings. A flashlight at night is useful for preventing falls as well.
Anxiety
Anxiety affects many people who travel. Fear of flying, fear of confined spaces, and worries about medical conditions worsening during flight are common sources of anxiety. Anxiety can cause insomnia, making jet lag worse. Companionship with a seasoned traveler or caretaker may help relieve anxiety. Cognitive therapy and desensitization programs may also help. Sedatives or antianxiety drugs may be necessary as well (see Section 7, Chapter 100).
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