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GP Dr Nick Jones advises on the specific pitfalls faced by certain types of traveller when abroad

Activities and their risks

Snow skiing puts particular strain on the knees and should not be undertaken if the patient has weak or injured knee ligaments. Other risks include:

· Environmental risks associated with altitude and cold

· Avalanches (off-piste skiing)

· Adverse effects of the sun, multiplied by the altitude and sun glare on the snow

Climbing and hill walking are hard on the knees and ankles and may involve ascent to high altitudes, which in itself can cause significant health problems. Other risks include:

· Gastrointestinal upsets

· Sun exposure

· Muscle and ligament sprains

· Backache

· Dry mountain air may cause nosebleeds

Seawater sports expose the traveller to a host of saltwater hazards while the glare of the sun on the water makes a high-factor (water-resistant) sunscreen essential.

Freshwater sports like canoeing or whitewater rafting carry the risk of infections from the water itself, including all of the water-borne diseases such as leptospirosis and schistosomiasis.

Strong currents can present a significant hazard when swimming. Buoyancy is less in fresh water

and this can make swimming

harder.

Scuba diving is physically strenuous and requires moderate degrees of respiratory and cardiovascular fitness.

Patients who suffer from angina, abnormal heart rhythms, severe asthma or chronic lung disease, or have had a pneumothorax in the past, should not dive.

If the patient suffers from panic attacks, anxiety or claustrophobia, scuba diving is not for them ­ a rapid ascent during a panic attack underwater is very dangerous.

Other diving hazards include:

· 'Squeeze', a painful condition caused by the sinuses and nasal air passages being blocked, which can result in damage to the eardrums; it can be brought on by the pressure changes that take place when diving, air pockets in the body contract on the way down and expand on surfacing

· A pneumothorax brought on by the diver holding their breath as they surface

· Decompression sickness ('the bends' or 'the staggers')

Useful websites

Gap year traveller

www.gapyear.com

www.gap.org.uk

Business traveller

www.fitfortravel.scot.nhs.uk

www.businesstravel.about.com

Diving

www.mtsinai.org

www.scubadiving.com

Nick Jones is a GP in Midsomer Norton, Somerset ­ this article is an adapted extract from his book The Rough Guide to Travel Health, 2nd edition, 2004

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