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Travel Medicine A Case of Multiple Sclerosis

Running head: Travel Medicine

Travel Medicine: A Case of Multiple SclerosisName:

Institution:

Course:

Tutor:

Date:

SummaryTravel medicine concerns itself with in depth evaluation of various environmental and personal factors that impact on the health of travelers. Travelers with multiple Sclerosis have unique needs that need to be addressed in order to enhance their quality of life. The disease is not only chronic but tends to be progressive and disabling. A critical understanding of the symptoms of the disease aids in quality therapeutic care by the care providers and the patients. Relative efforts need to be integrated to attain optimal results.

Traveling patients are obligated to take precautionary measures and ensure that they do not expose themselves to heat, maintain a healthy diet and limit alcohol consumption. Due to the hectic nature of traveling, they need to make timely preparations to prevent stress, depression and fatigue that exacerbate the symptoms. Most importantly, they should make prior consultations with the physicians and have a clear understanding of the environmental conditions of their destinations. Travel agencies can aid by providing sufficient facilities like wheel chairs and travel clinics. The government is obligated to enforce relative policies in order to safeguard the holistic wellbeing of MS patients.

Table of Contents TOC o “1-3” h z u HYPERLINK l “_Toc272253577” Travel Medicine: A Case of Multiple Sclerosis PAGEREF _Toc272253577 h 1

HYPERLINK l “_Toc272253578” Summary PAGEREF _Toc272253578 h 2

HYPERLINK l “_Toc272253579” Table of Contents PAGEREF _Toc272253579 h 3

HYPERLINK l “_Toc272253580” 1.0 Introduction PAGEREF _Toc272253580 h 4

HYPERLINK l “_Toc272253581” 1.1 Aims and Objectives of the Study PAGEREF _Toc272253581 h 4

HYPERLINK l “_Toc272253582” 1.2 Methods of Literature Review PAGEREF _Toc272253582 h 6

HYPERLINK l “_Toc272253583” 2.0 Literature Review PAGEREF _Toc272253583 h 6

HYPERLINK l “_Toc272253584” 2.1 Understanding Multiple Sclerosis PAGEREF _Toc272253584 h 6

HYPERLINK l “_Toc272253585” 2.3 Travel Medicine PAGEREF _Toc272253585 h 8

HYPERLINK l “_Toc272253586” 3.0 Recommendations: The importance of Travel Medicine PAGEREF _Toc272253586 h 12

HYPERLINK l “_Toc272253587” 4.0 Conclusion PAGEREF _Toc272253587 h 14

HYPERLINK l “_Toc272253588” 5.0 References PAGEREF _Toc272253588 h 15

1.0 IntroductionTravel medicine is an emergent multifaceted discipline that seeks to address the complex environmental and personal conditions that travelers grapple with while traveling. Since general conditions of different geographical global regions differ considerably, travelers are often susceptible to being affected by these in different ways. In some instances, this tends to be very extreme to the extent that patients require emergency medical attention. For this reason, it is imperatively important for travelers to undergo a pre travel health examination during travel time. Emergent research shows that patients suffering from multiple sclerosis are equally susceptible to far reaching implications that are related to traveling and should therefore seek medical consultation before traveling.

1.1 Aims and Objectives of the StudyThis study explores the implications of multiple sclerosis medical condition to travelers and measures that they can undertake to counter the related negative effects. In particular, it analyzes the nature of the disease in relation to the travel conditions. This analysis then provides insights in to measures that patients can undertake to enhance their holistic welfare. Multiple sclerosis is a neurological disease that affects the nervous system as it damages the myelin sheath of neurons. This results in the inability of the affected nerves to conduct signals accordingly, further culminating in the impairment of movement, sensation and cognition. Mutch (2010) cites that the disease is not only chronic but also progressive and disabling.

The conditions differ amongst patients although effective care and management is essential at all times. Optimal output in this respect is depended upon timely implementation of fundamental therapeutic activities. Statistical evidence shows that women are more susceptible to developing the condition than men. Burgess (2010) affirms that it caused by multiple genetic as well as environmental factors. Notably, the disease is fatal and this has prompted the need to explore its facets during travel. This is important in a bit to reduce the severity of h conditions that affect the quality of life of the patients. The purpose of this study is to offer useful insights with respect to how patients and other care takers can address relative concerns with ease.

The fact that it is progressive also implies that conditions of the patient can worsen during this time. It is imperative to ensure that intervention measures are put in place in a timely manner in order to save lives. Relative information from the doctor is also important in order to avoid incidences of shock during traveling. Notably, implications of multiple sclerosis affect not only the traveler patients but also the care givers and other travelers. The complex and intricate relations prompts the need for effective preparation of the patients before traveling. For patients with extreme conditions, it would be vital to not only consult the doctor but to also make arrangements regarding transporting the medicine. In this regard, Hargaten (1994) indicates that medicines such as copaxone might require refrigeration. Certainly, there is dire need to understand all the facets of medicine travel in this regard.

1.2 Methods of Literature ReviewThe information employed in this study is obtained from diverse primary and secondary sources evaluating the nature of travel medicine and multiple sclerosis. In particular, medical databases such as medline and med publications as well as website sources, journal and books will be used to provide credible information. A relationship between these two will be made in order to determine the travel medicine needs of multiple sclerosis patients. Based on the analysis of the findings of these sources, the study will provide viable recommendations that can be used to improve the holistic wellbeing of traveler suffering from these medical conditions. In this, the role of multiple stakeholders in countering the negative impacts will be detailed.

2.0 Literature Review2.1 Understanding Multiple SclerosisMultiple Sclerosis or MS is a chronic auto immune disease that was discovered in 1868. The Center for Disease Control and Prevention (2004) indicates that its prevalence is low, occurring at 2-100 in every 100,000 individuals. It mostly affects young adults between twenty and forty years and compared to men, women are more vulnerable. In his study, Kraft (1999) indicates that it is caused by both genetic and environmental conditions. Statistical evidence ascertains that its prevalence is high in Europe as compared to other global regions. The Northern United States, New Zealand and Southern Australia are particularly most affected. The mild symptoms include numbness in limbs although this may develop in a severe and disabling condition like loss of vision or paralysis (Frank, 2000). Some patients also exhibit secondary conditions that tend to be more severe and serious to the former. Also worth noting is the fact that the disease does not have standard conditions; rather these differ from one individual to another.

Mot, Snook and Schapiro (2008) indicate that multiple sclerosis is progressive and tends to worsen with time. Nevertheless, its course varies between individuals and as such, it is classified as relapsing remitting, progressive relapsing, and primary progressive or secondary progressive. Based on the conditions of the disease, it can be considered to be severe, mild, or moderate. With respect to the symptoms of the disease, Smeltzer and bare (2008) cite that these are multi, contributed to by diverse factors and highly personalized. However, Wade and Green (2001) found out that 87% of the patients have complained of fatigue. According to this study, 30-90% of the patients also complain of pain. Usually, every part of a patient’s body is liable to being affected because of impairment of the system’s local innervation. The muscle symptoms include numbness, imbalance, plasticity, problems walking, tremor, lack of coordination and weakness. Visual impairment is defined by uncontrollable eye movements, double vision, unilateral vision loss or general discomfort (Somer & Steffen, 2003).

Other symptoms include sexual dysfunction, slurred speech, difficulty in swallowing, memory loss, depression, poor judgment. Secondary complications are wide ad varied and range form urinary tract infections, occupational trouble and pressure ulcers to economic difficulties, marital problems and social isolation (Mutch, 2010). Therapeutic care is fundamental for managing this disease in an effective manner. However, Behrens and McAdam (1993) indicate that the patients and caregivers need to acquaint themselves with the dynamics of the disease. Further, knowledge and appreciation of the environmental and nutritional adjustment is of paramount importance. According to Carcione (2006), these have adverse effects on the course of this disease. In this regard, nutrition and environmental aspects reportedly contain triggers that often exacerbate relative symptoms like fever, extreme stress and depression, fatigue, allergens, a hot environment or infection. Practical and timely measures need to be undertaken to counter this and enhance relaxation techniques, proper nutrition, reduction of stress and sufficient rest.

With respect to the public knowledge about the dynamics of the disease, Freeman, Landgon, Hobart and Thompson (1997) ascertain that supportive institutions like the National Multiple sclerosis Society have been on the forefront with regard to increasing publicity about individuals with MS. Regardless of proving certain facilities such as the wheel chairs minimal efforts have been undertaken with regards to facilitating easy travel of these persons. This is essential to enhance sustainability of relative efforts pertaining to policy implementation and awareness creation.

2.3 Travel MedicineBefore traveling, Frank and Maguire (1989) advise the patients to psychologically and emotionally prepare themselves for the changes that they are likely to encounter. Long distance journeys have diverse impacts to patients and usually exposes to environments that they are unfamiliar with. Thus they are likely to suffer mental as well as emotional challenges that can emerge form this. From a psychological point of view, emotional preparation to face such challenges is beneficial as it reduces the effects of the negative impact on the patients. Zuckerman and Zuckerman (2001) explain that this preparation empowers the patients to address the problems with ease by eliminating possibilities of shock. It mentally familiarizes them to the travel experience and reduces anxiety that contributes to incidences of stress and depression.

Basically, traveling is a hectic exercise that exposes MS patients to a wide array of risks. In their review, Baker, Hagaten and Guptill (1992) indicate that traveling changes the environmental experiences of travelers. With respect to patients suffering form MS, traveling in other areas exposes them to different temperatures which might be higher than the expected. Graham and Roberts ascertain that overheating triggers varied MS symptoms that compromise the quality of life of the patients. To counter this, they are advised to not only practice deep breathing but to also take cold drinks. Also worth appreciating is the recognition that the very traveling experience is often stressing and can cause a rise in the body temperatures of the patients. This culminates in symptoms such as blurry vision that has adverse implications. This underscores the need for patients to be self cautious in order to address the symptoms in a timely manner.

Generally, Yung, Ruff, Torresi, Leder and O’Brian (2004) assert that travelers tend to experience different climates that have varied impacts on patients with MS. Findings of their study indicated that climates trigger relapses and often induce inflammation. In particular, hot climates are known to bring out latent or underlying symptoms. From the point of view of this study, patients can not avoid these climates altogether. Apart from taking cold drinks, MS patients can also dress appropriately. In particular, they need to wear hat and loose clothing during hot weather. Cooling garments that are employed by athletes also offer a viable option that can aid in countering the effects of the extreme conditions. Furthermore, Yung et al (2004) advises the patients to make prior arrangement and ensure that their destinations have air conditioned accommodations.

In their study, Dupont and Steffen (2001) assert that traveling exposes MS patients to dietary changes. This is particularly common with long distance journeys that are characterized by traveling to other global regions that have unfamiliar cultures. The respective changes in diets are likely to culminate in digestive problems. According to a study undertaken by Joule (2001), consumption of certain foods leads to constipation in MS patients. In addition, consumption of alcohol has been implicated for worsening the side effects of certain medications. Thus patients tend to experience drowsiness as well a memory problems. In this respect, patients need to make themselves conversant with diets in foreign regions in order to avoid relative problems. This can be attained through consultation with physicians in the respective regions. In addition, they need to refrain from consuming alcohol or keep its consumption minimal.

Traveling is also known for causing anxiety and fear in the patients. This is particularly common when the patients are not used to this and therefore face unfamiliar conditions. In a study undertaken by Jelink and Hassed (2009), findings affirmed that patients that suffer form multiple sclerosis often exhibited increase in stress levels during traveling. This exacerbate when they meet new peoples and experience cultures that they are unaccustomed to. The study also found out that family members accompanying the patients do not usually offer more than unwelcome pity and some take minimal measures to help them. The ability of the patients to set realistic expectations when on holiday for instance aids in countering the inherent impacts of negative experiences. Also, being bold and openly asking for help whenever n doubt can go a long way in easing the tension that can stem from unnecessary anxiety. This is also vital as it enables the persons around the patients to understand the nature of their conditions and how they can provide meaningful assistance. (Freeman et al, 1997; Leggat & Goldsmid, 2002).

When traveling, relative preparations and the intrinsic excitement or anxiety can also cause fatigue for patients with multiple sclerosis. This culminates form engagement in different tasks and activities that are both physically and emotionally draining. In their research, Walker, Boyne and Genasi (2001) found that increased fatigue in patients with MS often leads to difficulty to undertake a wide range of cognitive skills as well as effectively multi task to attain optimal output. For instance, patients might be unable to drive in the snow and deal with children in the car backseat. Further, the very act of traveling as well as spending nights in physical environments that are unfamiliar is very fatiguing. In such instances, patients can take the initiative of countering the negative impacts in different ways. Lockie (2000) suggests that taking naps in a bit to restore energy levels can be instrumental in addressing the problem. In addition, they need to refrain from committing themselves to multiple activities that are strenuous. Most importantly, they need to keep in touch with their families and friends and inform them of their personal conditions. This will reduce the strain they would offer help whenever need arises.

Having sufficient medication is an important aspect as these are essential for reducing the severity of the conditions. In this respect, patients traveling by air need to ensure that they have supporting notes from the physicians in case they are stopped at airports. If the trip would require that they be away from home for a longer period of time, thy need to carry enough medication to avoid running short of these. Travel resources (n.d.) found out that some patients reported forgetting their medication because of the stress that is related to packing. In this regard, patients need to give themselves sufficient time and avoid the last minute rush when packing. This would not only ensure that they pack all the vital requirements but it would also be imperative for avoid stress, depression and anxiety that is associated with last minute rush (Kozarsky & Freedman, 2004).

Further, it is important for patients to arrange for the transportation of their medicines. In this respect, Walker, Williams, Raeside and Calvert (1997) indicated that some medications require refrigeration. Providing the right temperature for these during traveling is imperative. In addition, they need to be clearly labeled in order to avoid problems with the customs. In this respect, Walker et al (1997) suggests that it is important to retain the original packaging of the medications. Alternatively these need to have an official labeling for easy identification.

3.0 Recommendations: The importance of Travel MedicineFrom the preceding analysis, it is certain that patients suffering from multiple sclerosis have diverse needs that need to be addressed in order to enhance their quality of life during traveling. Relative efforts need to be assumed at both the individual and institutional level in order to enhance the output of results. Before traveling, Solar, Filippini and Gasco (1999) agree that patients need to seek consultations. This entails a pre travel medical assessment and relative advice. This will ascertain the course of the disease and condition of the patients. An assessment would also aid in determining the type of treatment that such patients would require when traveling. Depending on their destinations, such advice would also provide insightful information with respect to the nature of their destination. This is important as it would enable them to make appropriate, sustainable and informed decisions pertaining to diet and accommodation.

Travel agencies also need to be on the fore front with regards to providing care for such patients. Besides mobility facilities such as wheelchairs, travel clinics would also be imperative. The clinics should be equipped with vital medical resources that are essential in addressing the emergent problems. In this respect, Greenwood, Barnes, Macmillan and Ward (1993) cite that such patients are susceptible to developing severe conditions while traveling. This is compounded by the realization that conditions tend to worsen with time. Development of severe symptoms can be caused by various reasons such as changing climates, diets, fatigue and stress and depression. Providing these services during traveling can aid in dealing with emergency cases. This would also ease the ensuing tension that has diverse implications on other passengers.

Patients also need to consult with the physicians in their destinations and maintain constant communication with the physicians at home. This is vital for understanding the progress of their condition. It aids in timely decision making with regards to measures that can be undertaken to counter any negative effects. Other practitioners can also provide insightful advice with regards to practical measures that can be assumed by the patient in order to enhance the quality of their stay in the destination. This has immeasurable benefits as physicians in their destinations have a better understanding of the impacts of multiple factors to the patients residing therein. They can therefore provide credible information to traveling patients.

Most importantly, traveling patients need to take personal initiatives to follow up their medical conditions. This is particularly so because they understand their conditions better than any other person. Besides they can take care of themselves accordingly using the information that they are provided with by the physicians and other credible sources. Besides these, the government needs to formulate, implement and enforce a policy that would ensure that all travel agencies or companies have enough facilities to diagnose the problem and provide treatment accordingly. Baker et al (1992) contends that this would reduce the fatal cases that result form patients traveling in high risk areas. Moreover, global governments need to provide sufficient medication for patients traveling in their regions.

4.0 ConclusionMany a times, travel medicine related to multiple sclerosis has not been accorded utmost attention. This has culminated in immense suffering of the victims who do not understand the nature of their conditions and useful intervention measures. From the preceding study, it is certain that the problem is complex and has far reaching implications on traveling patients. In order to counter the adverse impacts, patients need to take the personal initiatives with respect to keeping cool, avoiding stress, depression and fatigue, making consultations, limiting the consumption of alcohol, carrying relevant and sufficient medication and taking good diets. This would ease the severity of the conditions and enable then to safeguard their holistic welfare. The government is also obligated to ensure that travel agencies provide sufficient facilities and clinics to address emergent cases. This can be attained through implementation and enforcement of a relative policy.

5.0 ReferencesBaker TD, Hargarten SW & Guptill KS. (1992). The Uncounted Dead — American Civilians Dying Overseas. Public Health Report, 107: 155-159.

Behrens, R. & McAdam, K. (1993). Travel Medicine. British Medical Bulletin, 68

Burgess, M. (2010). Understanding Inflammation’s Role in Pathogenesis of Multiple Sclerosis. British Journal of Neuroscience Nursing, 6 (2), 60-64.

Carcione, J. (2006). Multiple Sclerosis Guide. Retrieved 14th September 2010 from: http://www.webmd.com/multiple-sclerosis/guide/multiple-sclerosis-exercise

Centers for Disease Control and Prevention (2004). Cruise Ships and Air Travel. Retrieved 14th September 2010 from: HYPERLINK “http://www.cdc.gov/travel/cruiships.htm” http://www.cdc.gov/travel/cruiships.htm

CCH Australia (1994). CCH Occupational Health and Safety Glossary. Sydney; CCH

International.

Dupont, H. & Steffen, R. (2001). Textbook of Travel Medicine and Health. USA: DC Decker.

Frank, O. (2000). Conservative Management of Low back Pain. Home Health &Care Consultant, 8, 16-23.

Frank, O. & Maguire, G. (1989). Disabling Diseases: Physical, Environmental and Psychosocial Management. Oxford: Heinemann Medical.

Freeman, J., Landgon, D., Hobart, J. & Thompson, A. (1997). Progressive Multiple Sclerosis. Neurology, 42, 236-244.

Graham, J. & Roberts, G. (2000). Making the Most of Life with MS: Adjusting to and Coping with Change. London: MS Society.

Greenwood, R., Barnes, M., McMillan, T. & Ward, C. (1993). Neurological Rehabilitation. Edinburgh: Churchill Livingstone.

Hargarten, W. (1994) Injury Prevention: A Crucial Aspect of Travel medicine. Journal of Travel Medicine, 1(1):48-50.

Jelink, G. & Hassed, C. (2009). Managing Multiple Sclerosis in Primary Care: Are We Forgetting Something? Quality in Primary care, 17 (1), 55-66.

Joule, N. (2001). Search of a Service: The Experience of People with Neurological Conditions. London: The Neurological Alliance.

Kraft, G. (1999). Rehabilitation Still the Only Way to Improve Function in Multiple Sclerosis. Lancet, 354: 2016-17.

Kozarsky, P & Freedman, M. (2004). Travel Medicine. USA: Mosby-Elsevier Science.

Leggat, P. & Goldsmid, M. (2002). Primer of Travel Medicine. 3rd ed. Brisbane:

ACTM Publications.

Lockie, C. (2000). Travel Medicine and Migrant Health. USA: Elsevier Health Science Division.

Mot, R., Snook, E. & Schapiro, R. (2008). Symptoms and Physical Activity Behavior in Individuals with Multiple Sclerosis. Research in Nursing and Health, 31 (5), 466-75.

Mutch, K. (2010). In Sickness and in Health: Experience of Caring for a Spouse with MS. British Journal of Nursing, 19 (4), 214-219.

Smeltzer, S. & Bare, B. (2008). Brunner & Sidduth’s Textbook of Medical Surgical Nursing. Philadelphia: Lippincott Williams & Wilkins.

Solari, A. Filippinni, G. & Gasco, P. (1999). Physical Rehabilitation has a Positive Effect on Disability in Multiple Sclerosis patients. Neurology, 52: 57-62.

Somer, R & Steffen R.(2003). Travel Health Insurance: Indicator of Serious

Travel Health Risks. Journal of Travel Medicine, 10, 185-189.

Travel Resources (n.d). National Multiple Sclerosis Society. Retrieved 14th September 2010 from: HYPERLINK “http://www.nationalmssociety.org/living-with-multiple-sclerosis/mobility-and-accessibility/index.aspx” http://www.nationalmssociety.org/living-with-multiple-sclerosis/mobility-and-accessibility/index.aspx

Wade, D. & Green, Q. (2001). A Study of Services for Multiple Sclerosis: Lessons for managing Chronic Disability. London: Clinical Effectiveness & Evaluation Unit, Royal College of Physicians.

Walker, E., Boyne, L. & Genasi, F. (2001). Color Guide: Travel Medicine. UK: Churchill Livingstone.

Walker, E., Williams, G., Raeside, F. & Calvert, L. (1997). The ABC of Healthy Travel. Cambridge: British journal of Medicine Publishing Group.

Yung, A., Ruff, T., Torresi, J., Leder, K. & O’Brien, D. (2004). Manual of Travel Medicine. Melbourne: IP Communications.

Zuckerman, J. & Zuckerman, A. (2001). Principles and Practice of Travel Medicine. London: John Wiley & Sons.

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Running head: Travel Medicine

Travel Medicine: A Case of Multiple SclerosisName:

Institution:

Course:

Tutor:

Date:

SummaryTravel medicine concerns itself with in depth evaluation of various environmental and personal factors that impact on the health of travelers. Travelers with multiple Sclerosis have unique needs that need to be addressed in order to enhance their quality of life. The disease is not only chronic but tends to be progressive and disabling. A critical understanding of the symptoms of the disease aids in quality therapeutic care by the care providers and the patients. Relative efforts need to be integrated to attain optimal results.

Traveling patients are obligated to take precautionary measures and ensure that they do not expose themselves to heat, maintain a healthy diet and limit alcohol consumption. Due to the hectic nature of traveling, they need to make timely preparations to prevent stress, depression and fatigue that exacerbate the symptoms. Most importantly, they should make prior consultations with the physicians and have a clear understanding of the environmental conditions of their destinations. Travel agencies can aid by providing sufficient facilities like wheel chairs and travel clinics. The government is obligated to enforce relative policies in order to safeguard the holistic wellbeing of MS patients.

Table of Contents TOC o “1-3” h z u HYPERLINK l “_Toc272253577” Travel Medicine: A Case of Multiple Sclerosis PAGEREF _Toc272253577 h 1

HYPERLINK l “_Toc272253578” Summary PAGEREF _Toc272253578 h 2

HYPERLINK l “_Toc272253579” Table of Contents PAGEREF _Toc272253579 h 3

HYPERLINK l “_Toc272253580” 1.0 Introduction PAGEREF _Toc272253580 h 4

HYPERLINK l “_Toc272253581” 1.1 Aims and Objectives of the Study PAGEREF _Toc272253581 h 4

HYPERLINK l “_Toc272253582” 1.2 Methods of Literature Review PAGEREF _Toc272253582 h 6

HYPERLINK l “_Toc272253583” 2.0 Literature Review PAGEREF _Toc272253583 h 6

HYPERLINK l “_Toc272253584” 2.1 Understanding Multiple Sclerosis PAGEREF _Toc272253584 h 6

HYPERLINK l “_Toc272253585” 2.3 Travel Medicine PAGEREF _Toc272253585 h 8

HYPERLINK l “_Toc272253586” 3.0 Recommendations: The importance of Travel Medicine PAGEREF _Toc272253586 h 12

HYPERLINK l “_Toc272253587” 4.0 Conclusion PAGEREF _Toc272253587 h 14

HYPERLINK l “_Toc272253588” 5.0 References PAGEREF _Toc272253588 h 15

1.0 IntroductionTravel medicine is an emergent multifaceted discipline that seeks to address the complex environmental and personal conditions that travelers grapple with while traveling. Since general conditions of different geographical global regions differ considerably, travelers are often susceptible to being affected by these in different ways. In some instances, this tends to be very extreme to the extent that patients require emergency medical attention. For this reason, it is imperatively important for travelers to undergo a pre travel health examination during travel time. Emergent research shows that patients suffering from multiple sclerosis are equally susceptible to far reaching implications that are related to traveling and should therefore seek medical consultation before traveling.

1.1 Aims and Objectives of the StudyThis study explores the implications of multiple sclerosis medical condition to travelers and measures that they can undertake to counter the related negative effects. In particular, it analyzes the nature of the disease in relation to the travel conditions. This analysis then provides insights in to measures that patients can undertake to enhance their holistic welfare. Multiple sclerosis is a neurological disease that affects the nervous system as it damages the myelin sheath of neurons. This results in the inability of the affected nerves to conduct signals accordingly, further culminating in the impairment of movement, sensation and cognition. Mutch (2010) cites that the disease is not only chronic but also progressive and disabling.

The conditions differ amongst patients although effective care and management is essential at all times. Optimal output in this respect is depended upon timely implementation of fundamental therapeutic activities. Statistical evidence shows that women are more susceptible to developing the condition than men. Burgess (2010) affirms that it caused by multiple genetic as well as environmental factors. Notably, the disease is fatal and this has prompted the need to explore its facets during travel. This is important in a bit to reduce the severity of h conditions that affect the quality of life of the patients. The purpose of this study is to offer useful insights with respect to how patients and other care takers can address relative concerns with ease.

The fact that it is progressive also implies that conditions of the patient can worsen during this time. It is imperative to ensure that intervention measures are put in place in a timely manner in order to save lives. Relative information from the doctor is also important in order to avoid incidences of shock during traveling. Notably, implications of multiple sclerosis affect not only the traveler patients but also the care givers and other travelers. The complex and intricate relations prompts the need for effective preparation of the patients before traveling. For patients with extreme conditions, it would be vital to not only consult the doctor but to also make arrangements regarding transporting the medicine. In this regard, Hargaten (1994) indicates that medicines such as copaxone might require refrigeration. Certainly, there is dire need to understand all the facets of medicine travel in this regard.

1.2 Methods of Literature ReviewThe information employed in this study is obtained from diverse primary and secondary sources evaluating the nature of travel medicine and multiple sclerosis. In particular, medical databases such as medline and med publications as well as website sources, journal and books will be used to provide credible information. A relationship between these two will be made in order to determine the travel medicine needs of multiple sclerosis patients. Based on the analysis of the findings of these sources, the study will provide viable recommendations that can be used to improve the holistic wellbeing of traveler suffering from these medical conditions. In this, the role of multiple stakeholders in countering the negative impacts will be detailed.

2.0 Literature Review2.1 Understanding Multiple SclerosisMultiple Sclerosis or MS is a chronic auto immune disease that was discovered in 1868. The Center for Disease Control and Prevention (2004) indicates that its prevalence is low, occurring at 2-100 in every 100,000 individuals. It mostly affects young adults between twenty and forty years and compared to men, women are more vulnerable. In his study, Kraft (1999) indicates that it is caused by both genetic and environmental conditions. Statistical evidence ascertains that its prevalence is high in Europe as compared to other global regions. The Northern United States, New Zealand and Southern Australia are particularly most affected. The mild symptoms include numbness in limbs although this may develop in a severe and disabling condition like loss of vision or paralysis (Frank, 2000). Some patients also exhibit secondary conditions that tend to be more severe and serious to the former. Also worth noting is the fact that the disease does not have standard conditions; rather these differ from one individual to another.

Mot, Snook and Schapiro (2008) indicate that multiple sclerosis is progressive and tends to worsen with time. Nevertheless, its course varies between individuals and as such, it is classified as relapsing remitting, progressive relapsing, and primary progressive or secondary progressive. Based on the conditions of the disease, it can be considered to be severe, mild, or moderate. With respect to the symptoms of the disease, Smeltzer and bare (2008) cite that these are multi, contributed to by diverse factors and highly personalized. However, Wade and Green (2001) found out that 87% of the patients have complained of fatigue. According to this study, 30-90% of the patients also complain of pain. Usually, every part of a patient’s body is liable to being affected because of impairment of the system’s local innervation. The muscle symptoms include numbness, imbalance, plasticity, problems walking, tremor, lack of coordination and weakness. Visual impairment is defined by uncontrollable eye movements, double vision, unilateral vision loss or general discomfort (Somer & Steffen, 2003).

Other symptoms include sexual dysfunction, slurred speech, difficulty in swallowing, memory loss, depression, poor judgment. Secondary complications are wide ad varied and range form urinary tract infections, occupational trouble and pressure ulcers to economic difficulties, marital problems and social isolation (Mutch, 2010). Therapeutic care is fundamental for managing this disease in an effective manner. However, Behrens and McAdam (1993) indicate that the patients and caregivers need to acquaint themselves with the dynamics of the disease. Further, knowledge and appreciation of the environmental and nutritional adjustment is of paramount importance. According to Carcione (2006), these have adverse effects on the course of this disease. In this regard, nutrition and environmental aspects reportedly contain triggers that often exacerbate relative symptoms like fever, extreme stress and depression, fatigue, allergens, a hot environment or infection. Practical and timely measures need to be undertaken to counter this and enhance relaxation techniques, proper nutrition, reduction of stress and sufficient rest.

With respect to the public knowledge about the dynamics of the disease, Freeman, Landgon, Hobart and Thompson (1997) ascertain that supportive institutions like the National Multiple sclerosis Society have been on the forefront with regard to increasing publicity about individuals with MS. Regardless of proving certain facilities such as the wheel chairs minimal efforts have been undertaken with regards to facilitating easy travel of these persons. This is essential to enhance sustainability of relative efforts pertaining to policy implementation and awareness creation.

2.3 Travel MedicineBefore traveling, Frank and Maguire (1989) advise the patients to psychologically and emotionally prepare themselves for the changes that they are likely to encounter. Long distance journeys have diverse impacts to patients and usually exposes to environments that they are unfamiliar with. Thus they are likely to suffer mental as well as emotional challenges that can emerge form this. From a psychological point of view, emotional preparation to face such challenges is beneficial as it reduces the effects of the negative impact on the patients. Zuckerman and Zuckerman (2001) explain that this preparation empowers the patients to address the problems with ease by eliminating possibilities of shock. It mentally familiarizes them to the travel experience and reduces anxiety that contributes to incidences of stress and depression.

Basically, traveling is a hectic exercise that exposes MS patients to a wide array of risks. In their review, Baker, Hagaten and Guptill (1992) indicate that traveling changes the environmental experiences of travelers. With respect to patients suffering form MS, traveling in other areas exposes them to different temperatures which might be higher than the expected. Graham and Roberts ascertain that overheating triggers varied MS symptoms that compromise the quality of life of the patients. To counter this, they are advised to not only practice deep breathing but to also take cold drinks. Also worth appreciating is the recognition that the very traveling experience is often stressing and can cause a rise in the body temperatures of the patients. This culminates in symptoms such as blurry vision that has adverse implications. This underscores the need for patients to be self cautious in order to address the symptoms in a timely manner.

Generally, Yung, Ruff, Torresi, Leder and O’Brian (2004) assert that travelers tend to experience different climates that have varied impacts on patients with MS. Findings of their study indicated that climates trigger relapses and often induce inflammation. In particular, hot climates are known to bring out latent or underlying symptoms. From the point of view of this study, patients can not avoid these climates altogether. Apart from taking cold drinks, MS patients can also dress appropriately. In particular, they need to wear hat and loose clothing during hot weather. Cooling garments that are employed by athletes also offer a viable option that can aid in countering the effects of the extreme conditions. Furthermore, Yung et al (2004) advises the patients to make prior arrangement and ensure that their destinations have air conditioned accommodations.

In their study, Dupont and Steffen (2001) assert that traveling exposes MS patients to dietary changes. This is particularly common with long distance journeys that are characterized by traveling to other global regions that have unfamiliar cultures. The respective changes in diets are likely to culminate in digestive problems. According to a study undertaken by Joule (2001), consumption of certain foods leads to constipation in MS patients. In addition, consumption of alcohol has been implicated for worsening the side effects of certain medications. Thus patients tend to experience drowsiness as well a memory problems. In this respect, patients need to make themselves conversant with diets in foreign regions in order to avoid relative problems. This can be attained through consultation with physicians in the respective regions. In addition, they need to refrain from consuming alcohol or keep its consumption minimal.

Traveling is also known for causing anxiety and fear in the patients. This is particularly common when the patients are not used to this and therefore face unfamiliar conditions. In a study undertaken by Jelink and Hassed (2009), findings affirmed that patients that suffer form multiple sclerosis often exhibited increase in stress levels during traveling. This exacerbate when they meet new peoples and experience cultures that they are unaccustomed to. The study also found out that family members accompanying the patients do not usually offer more than unwelcome pity and some take minimal measures to help them. The ability of the patients to set realistic expectations when on holiday for instance aids in countering the inherent impacts of negative experiences. Also, being bold and openly asking for help whenever n doubt can go a long way in easing the tension that can stem from unnecessary anxiety. This is also vital as it enables the persons around the patients to understand the nature of their conditions and how they can provide meaningful assistance. (Freeman et al, 1997; Leggat & Goldsmid, 2002).

When traveling, relative preparations and the intrinsic excitement or anxiety can also cause fatigue for patients with multiple sclerosis. This culminates form engagement in different tasks and activities that are both physically and emotionally draining. In their research, Walker, Boyne and Genasi (2001) found that increased fatigue in patients with MS often leads to difficulty to undertake a wide range of cognitive skills as well as effectively multi task to attain optimal output. For instance, patients might be unable to drive in the snow and deal with children in the car backseat. Further, the very act of traveling as well as spending nights in physical environments that are unfamiliar is very fatiguing. In such instances, patients can take the initiative of countering the negative impacts in different ways. Lockie (2000) suggests that taking naps in a bit to restore energy levels can be instrumental in addressing the problem. In addition, they need to refrain from committing themselves to multiple activities that are strenuous. Most importantly, they need to keep in touch with their families and friends and inform them of their personal conditions. This will reduce the strain they would offer help whenever need arises.

Having sufficient medication is an important aspect as these are essential for reducing the severity of the conditions. In this respect, patients traveling by air need to ensure that they have supporting notes from the physicians in case they are stopped at airports. If the trip would require that they be away from home for a longer period of time, thy need to carry enough medication to avoid running short of these. Travel resources (n.d.) found out that some patients reported forgetting their medication because of the stress that is related to packing. In this regard, patients need to give themselves sufficient time and avoid the last minute rush when packing. This would not only ensure that they pack all the vital requirements but it would also be imperative for avoid stress, depression and anxiety that is associated with last minute rush (Kozarsky & Freedman, 2004).

Further, it is important for patients to arrange for the transportation of their medicines. In this respect, Walker, Williams, Raeside and Calvert (1997) indicated that some medications require refrigeration. Providing the right temperature for these during traveling is imperative. In addition, they need to be clearly labeled in order to avoid problems with the customs. In this respect, Walker et al (1997) suggests that it is important to retain the original packaging of the medications. Alternatively these need to have an official labeling for easy identification.

3.0 Recommendations: The importance of Travel MedicineFrom the preceding analysis, it is certain that patients suffering from multiple sclerosis have diverse needs that need to be addressed in order to enhance their quality of life during traveling. Relative efforts need to be assumed at both the individual and institutional level in order to enhance the output of results. Before traveling, Solar, Filippini and Gasco (1999) agree that patients need to seek consultations. This entails a pre travel medical assessment and relative advice. This will ascertain the course of the disease and condition of the patients. An assessment would also aid in determining the type of treatment that such patients would require when traveling. Depending on their destinations, such advice would also provide insightful information with respect to the nature of their destination. This is important as it would enable them to make appropriate, sustainable and informed decisions pertaining to diet and accommodation.

Travel agencies also need to be on the fore front with regards to providing care for such patients. Besides mobility facilities such as wheelchairs, travel clinics would also be imperative. The clinics should be equipped with vital medical resources that are essential in addressing the emergent problems. In this respect, Greenwood, Barnes, Macmillan and Ward (1993) cite that such patients are susceptible to developing severe conditions while traveling. This is compounded by the realization that conditions tend to worsen with time. Development of severe symptoms can be caused by various reasons such as changing climates, diets, fatigue and stress and depression. Providing these services during traveling can aid in dealing with emergency cases. This would also ease the ensuing tension that has diverse implications on other passengers.

Patients also need to consult with the physicians in their destinations and maintain constant communication with the physicians at home. This is vital for understanding the progress of their condition. It aids in timely decision making with regards to measures that can be undertaken to counter any negative effects. Other practitioners can also provide insightful advice with regards to practical measures that can be assumed by the patient in order to enhance the quality of their stay in the destination. This has immeasurable benefits as physicians in their destinations have a better understanding of the impacts of multiple factors to the patients residing therein. They can therefore provide credible information to traveling patients.

Most importantly, traveling patients need to take personal initiatives to follow up their medical conditions. This is particularly so because they understand their conditions better than any other person. Besides they can take care of themselves accordingly using the information that they are provided with by the physicians and other credible sources. Besides these, the government needs to formulate, implement and enforce a policy that would ensure that all travel agencies or companies have enough facilities to diagnose the problem and provide treatment accordingly. Baker et al (1992) contends that this would reduce the fatal cases that result form patients traveling in high risk areas. Moreover, global governments need to provide sufficient medication for patients traveling in their regions.

4.0 ConclusionMany a times, travel medicine related to multiple sclerosis has not been accorded utmost attention. This has culminated in immense suffering of the victims who do not understand the nature of their conditions and useful intervention measures. From the preceding study, it is certain that the problem is complex and has far reaching implications on traveling patients. In order to counter the adverse impacts, patients need to take the personal initiatives with respect to keeping cool, avoiding stress, depression and fatigue, making consultations, limiting the consumption of alcohol, carrying relevant and sufficient medication and taking good diets. This would ease the severity of the conditions and enable then to safeguard their holistic welfare. The government is also obligated to ensure that travel agencies provide sufficient facilities and clinics to address emergent cases. This can be attained through implementation and enforcement of a relative policy.

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