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QUESTION: On an idyllic vacation in a tropical paradise, you suddenly feel ill. How do you know if your symptoms are serious enough to call a physician immediately, or to follow-up with your physician after you return home?

ANSWER: Usually, the biggest mistakes happen within 48 hours of arriving at that sun-drenched beach or exotic locale. This is when vacationers tend to overindulge on everything from cocktails splashed over ice cubes and limes, the tropical sun or enticing street food.

But common sense and preparation can decrease your risk. Before your trip, go to a travel clinic. You may need region-specific malaria pills, vaccinations or antibiotics. You should consider investing in travel medical insurance to ensure that you will have affordable access to well-trained, English-speaking physicians.

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Also carry a medical kit with you. Consider bringing: antibiotics for diarrhea; motion-sickness pills for sea sickness or car rides over rough terrain; hand sanitizer; your prescription medications in their original bottles; and a summary of your personal medical history. Don't forget to include bandages, antibiotic ointment for superficial cuts, DEET-containing insect repellent and, of course, remember your sunscreen.

By far, the most common travel-related illness is diarrhea caused by E. coli bacteria. Even expatriates returning to their homeland can fall ill with an upset stomach or something much worse. Washing hands and making the right food choices, such as avoiding the salad, ice cubes and uncooked food, can prevent this malady. However, if you do get it, it is best to treat it with the BRAT diet: bananas, rice, applesauce or toast. Drinking broth, ginger ale or Gatorade, rather than pure water, will help to restore electrolyte levels, essential in keeping our bodies functioning normally.

Anti-diarrhea medicines are not recommended for people whose diarrhea is caused by a bacterial infection or parasite because these organisms need to be purged from the intestines.

You should seek medical advice and strongly consider initiating antibiotic therapy, if you have one or more of the following symptoms: greater than three episodes of diarrhea in one day, a bloody stool, fever, severe abdominal cramping or pain.

One of the most common but puzzling rashes that afflicts travellers in the tropics is caused when droplets from citrus fruits, such as limes or lemons, splash on skin exposed to the sun. This rash, phytophotodermatitis, typically occurs because the citrus juice from a drink such as the popular Corona and lime is splashed accidentally onto skin, while tanning. The rash can appear up to 72 hours after exposure, and the lesions are usually red, irregular, often with blisters.

It is easily preventable by wiping off the citrus juice quickly from the skin or making sure that it does not splash onto the skin in the first place. The rash is caused when certain plant compounds found in lime or lemon juice, or in vegetables such as celery, are exposed to natural ultraviolet (UV) light. This makes the skin extremely sensitive to sunlight, and the rash is the result of this hypersensitivity. Going indoors after exposure is potentially preventative, because artificial light does not have the UV component which reacts with the sensitized skin. It usually takes 10 minutes or so for the reaction to occur after exposure to sunlight.

Any cuts which occur in a salt water environment should be taken seriously. Bacteria on the surface of coral, for example, can quickly cause any cuts to become infected. If you do suspect that your cut or scrape has become infected, be sure to seek medical attention.

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Your vacation does not end when you come home. A fever while travelling or after you have returned home is cause for concern, especially if you are or have visited malaria-prone regions such as Africa, Southeast Asia or India. Seek medical help immediately if you get a fever under these circumstances. Another important mosquito-borne illness is dengue fever, spread mainly by day-biting mosquitoes. Insect repellent applied after your sunscreen, plus loose clothes which cover the entire skin, is essential in protecting yourself from these mosquito borne illnesses.

Remember that many of the illnesses which you can get while travelling are unusual in North America, and can manifest themselves even months after you have returned home. Be sure to tell your physician where you have been, even if you are not asked. Most important, be smart, be prepared and have a safe holiday season.

Dr. David Carr is an emergency physician at the University Health Network in Toronto.

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