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with Rod Moser, PA, PhD

Stories from behind the examining room door, as told by Rod Moser, PA, a primary care physician assistant with more than 35 years of clinical experience.

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Monday, December 10, 2012

The Dance of the Worried Well

By Rod Moser, PA, PhD

Patient Speaking with Doctor

The weeks before any holiday period is a time when people begin to panic about illnesses, especially illnesses that may interfere with travel plans.  Even though they may not be sick at the moment, they may be showing signs of some inconvenient illness that they would like to ward off early, perhaps before it even starts.  Concerned people present with vague symptoms of fatigue, mild headaches, upset stomach, or feeling feverish (even with a normal temperature), or just some intuition that something bad is cooking. They are absolutely convinced that they will become ill and ruin a planned trip. They are the Worried Well: the people who are completely well, but hope that I can prevent them from becoming sick.

Many will come with stories of trips gone awry in the past: tear-jerkers about sitting in strange ERs for a simple ear infection; stories about mysterious rashes, sudden fevers, or explosive diarrhea. They are setting the stage for some pre-treatment requests.  As I listen to their stories, I often think I hear the faint sound of a sad violin playing. They are the people who feel that antibiotics, taken now, will prevent the progression of just about any impending illness. They are the Amoxiholics: the antibiotic-seekers.

Many schools were closed during the week before Thanksgiving, so families were making plans to go out of town, either to visit relatives or for a late fall vacation. In Northern California, families head for Disneyland like the swallows returning to Capistrano. The last several trips that my wife took to Disneyland involved at least one sick grandchild or invited guest. Even if you are not sick before you go to Disneyland, you may end up getting sick a day later. Disneyland has kids, and kids practice a lower level of personal hygiene. Yes, I said it. Kids are dirty, and they attract germs like Velcro. Many children in large amusement parks are sick and highly contagious. Families drag them there anyway.

Disneyland is perhaps one of the cleanest parks in the world, but not the most sanitized. Cleanliness is removing the trash, but sanitizing would require that anything people touch–ride handrails, picnic tables– be disinfected after each use. This doesn’t happen. It can’t happen. The Disneyland crew certainly keeps one hotbed of contagion sanitized — the bathrooms. They are immaculate and probably cleaner than any other public facility you might encounter.

No sooner have people recovered from Thanksgiving, then Christmas travel will be upon us. I suspect that people are packing bags right now. There will be crowded airports and airplanes, kissing relatives, handshakes and hugs from sniffling uncles, and raw turkey sitting on a wooden cutting board somewhere just waiting to give you Salmonella. Just traveling to a new geographic area exposes everyone to new circulating airborne pathogens. Children often become ill when you travel with them. That is just the way it is.

A few points to remember:

  • Illnesses have incubation periods, from less than a day to a week or more. Once you are sufficiently exposed, your body will try and fight off the invading pathogens. If your immune system wins, you don’t become ill. If it fails, you lose. Many people on planes are either sick or in a contagious incubation period. They will be sitting next to you, or coughing behind you.
  • Vaccines, like the influenza vaccine, are not protective as soon as the needle leaves your arm. It takes about two weeks before the protective benefits of the immunization is considered effective. Getting a shot on the way to the airport isn’t going to do it.
  • The severity of an illness depends on your immune system response. Children tend to get sick more often because their immune systems have been less challenged than that of a seasoned adult. If you had a similar illness in the past, your body will have some prior immunity. If you are exposed to a new germ, you will likely get sick. When you travel, there are LOTS of new germs.
  • Most contagious illnesses are viral and viruses cannot be prevented by taking antibiotics either before or during the illness. Antibiotics have their place in treating bacterial illnesses, but with viruses, we are on our own.
  • Past experiences with illnesses while traveling does not accurate predict future experiences, but history has this annoying way of repeating itself.

Some travel tips for the Worried Well:

  • Don’t pressure your medical provider to give you antibiotics in advance for illnesses you may not get. However, you should make sure that you have plenty of medicines that you or your family take on a regular basis. Running out when you are out of town can be a problem.
  • When you get to a new destination, find a good pharmacy and get their phone number and fax. Have this handy if you need to call your regular medical provider back home. Don’t expect that you will automatically be treated over the phone.
  • Find an urgent care center at your destination, and jot down their hours.  The ER is the place for serious or life-threatening emergencies, but not the best place to have a child seen for a possible ear infection. If you do, you must enjoy waiting for hours while others are triaged before you, or you like to pay high medical bills or co-payments.
  • Make a travel sanitation kit: Travel with some disinfected wipes or Sprays, like Lysol (my personal favorite).  Spray the tray tables and arms of the airplane seat. This may be the only time this has been properly disinfected in months! Take it with you to the airline bathroom, too.
  • Preach and practice good hand-washing until you are blue in the face. Use hand sanitizers often.
  • If you are traveling by car, pick your pit stops carefully. Check out the public restrooms BEFORE your kids go running in there.  Go to nice, clean restaurants or pack your own food and beverages for a car trip.
  • If one of your kids has a runny nose when they arrive at your destination, try and ignore it. They already have a cold; it’s too late. Anyone who kisses them does so at their own risk. Don’t medically isolate them from others unless you have a darn good reason.
  • Make sure that everyone’s immunizations are up to date, especially seasonal influenza. Traveling is how influenza goes on vacation, too. Someone traveling with the flu in California can spread it to dozens of people on the plane, and to innocent friends and relatives at your destination. Exposing a great-grandmother to influenza is not a nice holiday gift, although it is one that “keeps on giving”.
  • Consider staying home for a good, old fashioned holiday. They tend to be safer, cheaper, and just as memorable.  Invite people to your house. Make them endure all of the hassles of traveling.

Try not to worry. Have a wonderful, safe, and healthy holiday, wherever you are, and whatever you do.

Photo: Comstock

Posted by: Rod Moser, PA, PhD at 1:00 am

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