Zika and Holiday Travel: Should You Delay Your Holiday Trip?

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Depending where you're going, the answer is likely yes. Snow approaches and people leave. Winter holidays are, for many of us, travel times – we run to warmer weather, or to the warmth of our families and loved ones to celebrate the holidays. But this year, there's a reason to stay home, one that has nothing to do with ticket prices or airline delays. As I often tell patients in my obstetric practice at Montefiore Health System in Bronx, New York, Zika is still a major cause for concern in certain areas around the world. Here's the thing about Zika: It's a potent combination of terrifying and unknown, it infects many people and, while most get better without ever having symptoms, if you're a pregnant woman, the Zika virus can be a never-ending nightmare. Zika has a tremendous affinity for developing neurons, the building blocks of our nervous system. The virus also has tricks for sneaking past the placenta – the organ grown during pregnancy that connects mom to the baby and generally protects the growing fetus from infection. The Zika virus, however, knows how to get past the the placenta. Once it does, it targets fetal neurons and can cause extensive brain damage to the fetus, including an irreversible condition known as "microcephaly," where the baby's head does not fully develop. One of the hard things about Zika is how much we don't know. Even with state-of-the-art ultrasound, we can't see the effects of a Zika infection right away – or sometimes at all. Zika-infected fetuses can look completely normal in the 20-week scan, and only in the third trimester can we detect that the head has stopped growing. Blood tests are similarly limited. We can test for the virus and for an immune reaction against the virus, but if those are negative, it still doesn't tell the full story. Maybe you had Zika, but just too recently for us to see it, or too long ago for our blood tests to detect it. While the majority of Zika virus comes from a mosquito bite, it can also be sexually transmitted if someone with the active infection has sex with someone who has never been exposed. There is no treatment or vaccine for Zika, leaving very little options after exposure. Once exposed, it becomes hard to feel safe. This is why prevention is the leading strategy for public health experts, including recommendations from most public health organizations for pregnant women to avoid travel to Zika-affected areas. It is also the reason that I have conversations with women at my clinic daily about travel risks. The map of countries with active Zika transmission has expanded over the past few months. The Centers for Disease Control and Prevention, plus other public health agencies, strongly recommend that women who are pregnant or are planning to become pregnant – and their sexual partners – avoid traveling to impacted areas. Women who are excited to travel to the Bahamas, Puerto Rico or even parts of South Florida, for example, come to me for what was intended to be a routine prenatal visit, and I have to tell them about the realities of Zika today. I tell them I don't think this vacation is a great idea for now, and we highly recommend they reschedule the trip for after the pregnancy. I try not to frighten them, but the idea of brain damage in a baby is scary. Women tend to agree that postponing travel is worth the peace of mind that accompanies an informed decision. If my patients still have to go on their trip – and sometimes they do because life is complicated – there are ways to reduce the risk of contracting Zika. For example, at-risk travelers can wear clothing that will protect them from mosquito bites, including long pants and long-sleeved shirts; they can also wear clothing and gear sprayed with the anti-mosquito agent permethrin. Pregnant women should also use insect repellant with DEET (an EPA-approved bug spray which research shows to be safe in pregnancy if used as directed) or other recommended agents. A bed net might be useful if sleeping in a room with open windows. Since Zika can be sexually transmitted, we recommend using condoms with a partner who has traveled to those Zika-epidemic areas for the rest of the pregnancy to protect the pregnant woman and the fetus.  The medical community is working round-the-clock to develop a vaccine, but until we reach a breakthrough, unfortunately pregnant couples have one more thing to consider. If you can post-pone your trip to a Zika-affected area, please do; instead, perhaps you can plan a doubly fantastic trip in a year or two. You will deserve it.

• 10 Seemingly Innocent Symptoms You Shouldn't Ignore

  
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  Hypochondria – or reality?Is that bump an ingrown hair – or a tumor? Is your stomach pain an exercise cramp – or appendicitis? And about that headache: dehydration – or an aneurism? “A lot of times, people are worried they have the rarest cancer you’ve ever heard of on the Internet,” says Dr. Joshua Tobin, director of trauma anesthesiology at the University of Southern California Keck School of Medicine. “Almost never is that the case.” Phew. But too often, patients brush off seemingly benign symptoms that could signal something serious. If any of these 10 issues strike you, don’t wait until it’s too late to seek medical attention:

• 1. Unexpected indigestion

  
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  If Taco Tuesday never bothered you before, stop blaming your "heartburn" on $5 margaritas and queso dip and consider calling 911 – particularly if you have other risk factors for heart attacks, such as being over 65 years old and having high cholesterol, or if the pain feels left-sided, travels down your left arm or leaves you sweating profusely, says Dr. Ernest Brown, a family medicine physician in the District of Columbia. Adds Dr. Fred Bove, past president of the American College of Cardiology: "Indigestion is ... usually related to a digestive problem, [but] occasionally, it is a cardiac symptom that is a precursor of a heart attack."

• 2. Something in your eye that won't go away

  
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  While it's hard to ignore a condition like pink eye – its name says it all – one of the most serious and time-sensitive eye conditions is also one of the easier to brush off. Retinal detachment, or when the light-sensitive layer of your eye pulls away or tears, can blind you. But the symptoms – an increasing number of specks, flashes of light or a "curtain" covering your field of vision, according to the National Eye Institute – are painless and invisible to an outsider and the mirror. If you notice any of these changes, see an eye care professional immediately, NEI advises.

• 3. Surprise weight loss

  
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  At first, sliding more easily into your skinny jeans may come as a pleasant surprise. But losing 10 pounds or more for no clear reason – you haven’t, for instance, taken your fitness regimen up a notch, started a newly diligent diet, tamed your cravings by sleeping more or even lost your appetite due to stress – can be the first sign of cancer, according to the American Cancer Society. Cancers of the pancreas, esophagus, stomach and lung are most often linked to unexplained weight loss.

• 4. Increasing – and unexplained – belly bloat

  
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  Can’t quite button your pants? “When patients have weight gain, the most common reason is definitely poor dietary choices and inactivity,” says Dr. Stephanie Romero, an assistant professor of obstetrics and gynecology and maternal-fetal medicine at the University of South Florida Morsani College of Medicine. But if those reasons don’t check out with your belly’s growing girth, you could have an abdominal cancer like ovarian cancer, Romero says. Abdominal swelling, Bove adds, can also be a sign of heart failure, which often causes fluid retention.

• 5. Painful periods

  
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  If that time of the month is excruciatingly painful, you plow through super-size tampons like nobody's business or your flow is woefully unpredictable, consider it a red flag, Romero says. Treatable but frequently undiagnosed conditions like endometriosis and polycystic ovarian syndrome – top causes of infertility – could be to blame. Fibroids, or noncancerous tumors in the uterus, or even pregnancy might also be culrpits. Any changes in your cycle, for that matter, warrant a trip to the gynecologist, Romero says. “Any unusual pattern to menstruation deserves a mention to the gynecologist," she says, "particularly if it represents a change from what had been going on in the past.”

• 6. Walking- or stair-climbing-induced leg cramps

  
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  Any athlete will tell you leg cramps are just the name of the game. But if the pain is tied to walking, relieved by rest and hits consistently when you stride or climb stairs, don't brush it off as soreness – those cramps could be caused by peripheral artery disease, or when blood flow to the legs gets impinged due to clogged arteries, says Bove, a member of the American College of Cardiology Patient-Centered Care Committee. If the condition goes undiagnosed, the cramps can get more painful and even lead to the loss of your leg, according to the American Heart Association. “When symptoms persist or recur,” Bove says, “a medical checkup will help to find the answer.”

• 7. New or changing moles

  
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  It’s springtime in Southern California, and Tobin, who’s fair-skinned, is on high alert for moles. “Ninety-nine times out of 100, it’s nothing,” he says, but if the mole is asymmetrical, has funky borders, different colors or is larger than a pencil eraser, visit a dermatologist who can determine whether it’s melanoma. If it is and it's caught early, it's usually relatively simple to "cut out," Tobin says. Brown adds that African-Americans are particularly at risk for overlooking cancerous moles, which can even hide under toenails. “There’s certain things you don’t want to miss,” he says, “and skin cancer is one of them because it’s so aggressive.”

• 8. Super dry skin

  
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  Maybe it’s winter – or maybe it’s a thyroid hormone abnormality, says Dr. Chris Adigun, a dermatologist in Chapel Hill, North Carolina, who notes that thinning hair often accompanies this symptom when it’s linked to a thyroid issue. Dry skin paired with seriously peeling nails, meantime, can be a sign of zinc deficiency. In either case, visit your primary care physician, who can identify the cause and a solution, be it supplements or simply lotion.

• 9. Breast changes

  
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  Puberty has passed (thank goodness), you're not breast-feeding and there's no other clear reason for your breast changes – think nipple discharge, different-looking skin, pain or a lump – so why not visit your gynecologist? "You would think people would seek care for these things, and often they do," Romero says, "but I’ve had patients show up with advanced-stage breast cancer who then recall having some of these changes for years." In these cases and others, better safe than sorry.

• 10. An unproductive cough

  
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  Coughs are annoying but harmless, right? Not quite. Patients who are on a breed of blood pressure medications called ACE inhibitors can develop "a persistent, non-productive cough that keeps them up at night," Brown says, and yet many "let it go on and on and on." It's just one example of a medication side effect that patients ignore – and of a condition that, in many cases, could have been prevented through lifestyle changes, Brown says. Tobin takes a similar stance: "Diet and exercise," he says, "is the key to a healthy and happy life."

source : U.S. News & World Report - Health (http://www.usnews.com/)

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