It is important to visit your physician months before you plan to visit or move to Peru. Only you and your physician know what medications you need on a daily, monthly or annual basis. It is important to purchase any prescriptions you may need while away. It is also a good idea to get a check up before you leave in order to avoid having to do it here. Be sure to bring any health items that you use on a regular basis at home, such as Advil or Tylenol, Peptobismal, or birth control.  Once here, it is only a matter of time before you will need to find a primary physician, gynecologist, and dentist. Much like at home, it is best to find these doctors through personal referrals. Although each individual has specific health issues to address, there are several precautionary measures everyone must take before arriving to. The following information provides an outline of illnesses common to Peru and what precautionary measures can be taken to prevent them. Health Care Inoculation
About Cholera
Malaria & Yellow Fever
Malaria Medications Mefloquin(Larium)-Begin taking it two-and-a-half weeks (3 doses) before departure. Stop taking medication immediately if side effects such as nightmares, mood swings, restlessness, dizziness, or gastro-intestinal symptoms. Malaron(Proguanil with Atovaquone)-Begin taking it one to two days before travel. Good for malaria region of up to 28days, through it is probably safe for 2.5 months. Best taken with food or milk. Cannot be purchased in Peru. Must be purchased from the United States or Europe. Doxycycline- Begin taking it one to two days before travel. Side effects include sensitivity to sun exposure and loss of appetite. Chloroquine & Proguanil (Nivaquine, Aralen or Resochin & Paluadrine)- Begin taking one week before travel. Proguanil/or Paludrine in the U.K. is not available in the USA. Chloroquine & Proguanil combinations are the only anti-malaria medications available in the UK without a physician's prescription. It is the only pediatric antimalaria medication, although it is so bitter that few children can tolerate it, even when taken with food. Info & Useful Websites CDC Healthlink NHS Direct Netdoctor MDTravelHealth Expedia Food & Drink There is a useful saying that applies to Peru: "Peel it, boil it, cook it or forget it." As your system adjusts to a change in diet, it is not unusual to experience a bout of diarrhea. Give your stomach a break for 24 hours; eat lightly if at all; drink lots of fluids, and slowly build up your tolerance. Medicines for diarrhea can be purchased in pharmacies, but be sure to check expiration dates. Diarrhea causes dehydration. Drink lots of hot fluids and replace electrolytes with re-hydration salts. Do not drink tap water anywhere in Peru unless it has been boiled for 5 minutes or treated with iodine. (Note: boiling water at high altitude is less effective since water boils at a lower temperature at altitude.) Iodine kills all known pathogens, including giardia. You can neutralize bacteria, viruses and protozoa with tincture of iodine (5 drops to one quart). Iodine crystals are available in many camping stores in the United States and Europe. You can mask the iodine taste with lemonade mix or an iodine taste neutralizer that is sometimes provided. Add oral re-hydration salts or drink Gatorade to replace minerals. Travelers should bring sufficient water treatment tablets/iodine crystals, a water filter or be prepared to boil water whilst in Peru. Alternatively, bottled water is available in one or two liter bottles. Other bottled beverages are also safe to drink. Water Purification Water can play a major role in the transmission of enteric infections, and virtually all of the agents that cause travelers' diarrhea may be present in contaminated water. Anywhere that trekkers are able to travel these days, people live or travel higher up; consider all ground water to be contaminated. Travelers wishing to avoid diarrhea should not consume untreated water. Various water treatment methods are reviewed below. Bottled Water is only as safe as the source. There are recorded instances of contaminated bottled water contributing to cholera epidemics. Carbonated water is acidic enough (due to the dissolved carbon dioxide) to kill contaminating bacteria. Bottled water has the disadvantage of being an additional expense, and is not always available. We also discourage trekkers from relying on bottled water for the simple reason that all of these plastic bottles are carried into the mountains, and few are carried out, producing a tremendous and completely unnecessary waste disposal problem. Heat kills microorganisms, and virtually all enteropathogens are readily killed at temperatures well below the boiling point. The process of heating water to a boil makes it hot enough long enough to disinfect it, even at elevations as high as Everest Base Camp. There is no need to boil water for 10 or 20 minutes, as some guidebooks recommend. Bringing water to a boil is adequate for disinfection. Chemical Disinfection of water relies on the killing of bacteria (Giardia and amoeba cysts) and viruses. Halogens (chlorine and iodine) are the most commonly used. The important point is that the effectiveness of the chemical is dependant on concentration of the chemical, temperature of the water, and contact time. Decreased concentration (better flavor) or decreased temperature (inevitably the case in the mountains) requires a longer contact time for disinfection. Sediment (cloudy water) increases the need for a halogen. Bear in mind that adding flavor crystals to your water will use up the halogen and should only be done AFTER the recommended contact time for disinfection. Remember: "Add Flavor Later." Chlorine has been used for several centuries for water disinfection. The most common objection to it is the flavor, though there have been some suggestions that it is unreliable in killing Giardia cysts in commonly used concentrations. Halazone tablets are convenient and inexpensive, but have several disadvantages. Due to their chemical formulation, reliable disinfection in all conditions requires 6 tablets per liter for 1-hour contact, resulting in poor flavor. Additionally, the tablets rapidly lose effectiveness when exposed to warm, humid air. Supterchlorineation, Decholorination is a two-step method is somewhat inconvenient, and the chemicals needed are destructive to clothing and gear if spilled, but it is highly effective and results in nearly flavorless water. This process works as high concentrations of chlorine are developed, and then in a second step removed by the addition of peroxide. Iodine has been used to disinfect water for nearly a century. It has advantages over chlorine in convenience and probably efficacy; many travelers find the taste less offensive as well. It appears safe for short and intermediate length use (3-6 months), but questions remain about its safety for long-term use. It should not be used by persons with allergy to iodine, persons with active thyroid disease, or pregnant women. Iodine is available in numerous forms, which can be confusing to the traveler.
DISINFECTING CONTACT TIMES
NOTES:
Filtration works by physically removing infectious agents from the water. The organisms vary tremendously in size, from large parasitic cysts (Giardia and Entamoeba histolytica 5-30 µm), to smaller bacteria (E. coli 0.5 x 3 µm, Campylobacter 0.2 x 2 µm), to the smallest viruses (0.03 µm). Thus, how well filters work depends to a great extent on the physical size of the pores in the filter medium. Filters provide immediate access to drinking water without adding an unpleasant taste. However, they suffer from several disadvantages: micro cracks or eroded channels within the filter may allow passage of unfiltered water, they can become contaminated, and no filters sold for field use are fine enough to remove virus particles (Hepatitis A, rotavirus, Norwalk virus, poliovirus, and others). In addition, they are expensive and bulky compared to iodine or other treatment methods. Some filter manufacturers have added an iodine resin layer to the filter in order to kill any agents passing through the filter stage. Data on effectiveness is limited, but some models have still been shown to provide incomplete disinfection of contaminated water. High altitude Altitude Sickness This information is intended to be educational in nature and should not be construed as medical advice. You should consult your physician regarding any specific medical conditions or questions and before taking any medications or departing on your trip. This information has been taken from the High Altitude Medicine Guide (http://www.high-altitude-medicine.com/) and further information is available from this site. As one ascends through the atmosphere, barometric pressure decreases (though the air still contains 21% oxygen) and every breath contains fewer and fewer molecules of oxygen. One must work harder to obtain oxygen, primarily by breathing faster. This is particularly noticeable with exertion, such as walking uphill. Being out of breath with exertion is normal, as long as the sensation of shortness of breath resolves rapidly with rest. Acclimatization is the process of the body adjusting to the decreasing availability of oxygen. It is a slow process, taking place over a period of days. Certain normal physiologic changes occur in every person who goes to altitude:
As the amount of oxygen in the lungs decreases, the blood becomes less and less efficient at acquiring and transporting oxygen. This means that no matter how fast one breathes, attaining normal blood levels of oxygen is not possible at high altitude. As long as you are awake, it is not much trouble to remember to breathe, but at night, an odd breathing pattern develops. Periodic breathing consists of cycles of normal breathing, breath-holding, and accelerated breathing. The breath-holding may last up to 10-15 seconds. This is not correlated with altitude sickness. It may improve slightly with acclimatization, but does not usually resolve until descent. Periodic breathing can cause a lot of anxiety in trekkers. If periodic breathing symptoms are troublesome, a medication called acetazolamide may be helpful. Acute Mountain Sickness (AMS) Who can get AMS? RECOGNIZE AMS. In the context of a recent ascent, a headache, with any one or more of the following symptoms above 2,500 meters (8,000 feet) qualifies you for the diagnosis of AMS:
It is remarkable how many people mistakenly believe that a headache at altitude is "normal" when it is actually AMS. Be willing to admit that you have altitude illness. How to Avoid AMS At altitudes above 3,000 meters (10,000 feet), your sleeping elevation should not increase more than 300 meters (1,000 feet) per night, and every 1,000 meters (3,000 feet) you should spend a second night at the same elevation. What To Do If You Have AMS The Severe Forms of AMS -- High Altitude Cerebral Edema (HACE) The hallmark of HACE is a change in cognition, or the ability to think. There may be confusion, changes in behavior, or lethargy. However, it is probably easier to recognize a characteristic loss of coordination that is called ataxia. This is a staggering walk that is identical to the way a person walks when very intoxicated. The treatment is immediate descent. This must be done as soon as possible and cannot wait until morning (unfortunately, HACE often strikes at night). Delay may be fatal. How far down? At least to the last elevation at which they woke up in the morning with no symptoms of AMS. High Altitude Pulmonary Edema (HAPE)
The treatment for HAPE is the same as for HACE: immediate descent. As with HACE, it is of the utmost urgency; delay may be fatal. The same rules apply for how far as well: to the last elevation where the victim felt well upon awakening. Things to Avoid
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