Friday, November 29, 2013

"Packing for the Road"

From Journal of American Medical Association Nov 27, 2013: Volume 310, #20

Packing for the Road
by Corey Fogelmanm MD

Packing for the road is a way
Of lightening the load. So much
That crowds the mind can at
Last be left behind. Yet if we
Leave what gimbals the keel, how
Off-center the chest can feel.
Perhaps we are nomads at our
Core, connected to what's
Essential and nothing more.

     My husband and I are seasoned travelers as you can tell from the many travel blogs on this site. Over the years of our peripatetic activities we have slowly learned how to pack very very light.

     Of course exactly what we take depends considerably on the nature of the trip. When we went to Antarctica, we were on a cruise ship but it was a casual cruise ship. We did not need dressy dresses, evening pants suites, or sports jackets. But we were going ashore in Antarctica so we needed layers of warm clothes. The Hurtigruten cruise ship provided an outer parka and boots but we were to bring fleece liners, long underwear, warm wool socks for in the boots, etc. We have taken other cruises with Oceania and though evening dress is optional, we both did feel the need to dress up for the fancy restaurants on board. We also felt the need to wear something different for our dinner partners. You are seeing at least some of the same people again and again at mealtime and for that matter throughout the day on the ship. On the good side, you only handle your baggage a few short times from the baggage claim to the cab to the ship terminal and back to the airport. After that the luggage is the responsibility of the shipboard crew. And you unpack once for the whole trip which is very convenient. Therefore, for all these reasons, we packed more clothing changes and a variety of dressy and very casual clothing for that trip.
     Our most recent trip was to Kenya and Tanzania on safari. There was no fancy dining and we would only be seeing our guides for a few days in a row, so we could pack very casual sage and beige safari pants and shirts and they could be laundered at several places that were announced in the beginning. Therefore our supply of clothing was quite small. The only non safari dressy casual outfit I took was to fly in. I went with a small so called "two suiter" bag.

     We have been taking two big international trips now for the last 10 years. During that time our bodies have aged 10 years and our medical needs have also advanced. Now a large percentage of our luggage is occupied by our medical needs and related items that reflect our stage of life. In addition to our daily medications, and certain medical machines (my husband's sleep apnea CPap breathing machine), as a former doctor, I take all kinds of "just in case" items in both the medication and the treatment categories. Would you like to see a list of these health related items that we take along?

1. Regular daily medication for how ever many weeks the trip is long, plus at least 2 weeks extra of medication. For me this includes blood pressure meds, cholesterol meds, aspirin, various vitamins,  prednisone for my polymyalgia rheumatic, and short acting and long acting basal insulin for my diabetes mellitus.  For my husband, there are also blood pressure meds, 3 different cholesterol lowering drugs.
2. Just in case drugs---just in case we get some illness or symptoms that require treatment. Remember I have an MD and still retain some of the knowledge that I used for years to treat my patients. So we take: anti inflammatory meds, various antibiotic pills and creams, meds for mild pain and for severe pain (My husband has passed a kidney stone on one of our trips -- that is supposedly one of the most severe types of pain.) I take extra larger doses of my prednisone in case I get a flare up of the polymyalgia rheumatic while on the trip.
3. Quite often we have traveled to tropical areas where we needed to take antimalarial pills.
4. I have sprained my knee on our Turkey trip and have certainly sometimes gotten blisters from walking a lot. So we take Ace Bandages, corn plasters, moleskin and other tapes and elastic plasters.
5.  A year ago on our Iceland and Greenland trip, my husband's legs swelled up quite a bit and he developed a venous stasis ulceration on his leg which wept yellow fluid for half of the trip. When he came back home he had to wear what's called an Unna Boot for about 5 weeks to get this ulcer to heal and to keep the swelling down in the leg. So now I travel with gauze, and antibiotic cream, and even the set up for an Unna boot so I could apply one in a pinch and help an ulcer heal or at least not let it get too big.
6. Amos has a very bad back and can't walk very far. I have some degree of backaches and I can't stand in one place for a long time, as during sightseeing tours of museums and historical sites where we stand to listen to the guide for sometimes quite lengthy historical talks. So we both carry our own foldable cane and foldable stool that you can put in a backpack and take with you.
7.  Amos has sleep apnea and so now for the last two trips we have traveled with a CPap machine to keep his airway open. And in Africa, there were no electrical plugins for the machine, so he carried two quite heavy batteries that could be plugged in at the main office of the camp during the day to charge them up for use throughout the night to keep that machine running.
8.  I am diabetic and so I must travel with two types of insulin and the needles and syringes needed for those with much extra supplies. Also I carry at least two glucose monitoring meters with extra batteries and extra test strips. I pack a supply of all of these items in at least two different locations within our baggage so that if one bag doesn't come through, I still have a supply from another bag. I also need a rapid supply of glucose should my sugar fall too low. And I even carry injectable glucagon which can be used in severe hypoglycemia when the person can not take anything by mouth. I had to go to the ER for such a low almost unresponsive level of blood sugar in May so now I am being extra careful.

     This all just makes me jealous of the youngsters who are traveling and need no meds, and no "just in case" items. That means my advice to you is to get on the road now while you are young and you can truly travel "light," with only "what's essential and nothing more."

    After reading the above, some of you might say: "What in the world are these sick and old people doing on these distant and risky trips?" My only answer is: If you have the travel bug like we do, and we all get old, someday you will understand why we do this. Actually on our trip to Russia, while on the river cruise of the Volga River, an elderly man who was traveling with his daughter and who was terminally ill, died. He and his daughter had talked about this possibility and she was prepared. She finished the trip, and the cruise people did a marvelous job of handling the father's remains, sending it back to Moscow where the daughter could meet up with it at the end of the cruise and accompany the casket home. Now I do admit that this is an extreme case and I wouldn't want it to happen to me, but it just shows that people who have the travel bug are really very infected.

     Back to packing! Here is a general list for packing that reminds me about what I might need for each trip. I keep many of these travel items together in a small bag and I just go through it before each trip and decide how much of it I will pack for that particular trip. For example for some tropical trips I definitely want my small portable personal battery operated fan, but I certainly didn't need that for the cruise to Iceland and Greenland. By going through this bag of possible items I might need I am sure to have what I need for each specific trip.

List of Items to take along on travels:
 Imodium AD, PeptoBismol, antacids, and laxatives.
 An oral rehydration solution such as Ceralyte. Probably easier to find at foreign pharmacy.
 Water purification tablets, if likely to be exposed to questionable water
 An all purpose antibiotic such as ciprofloxacin to treat respiratory, infectious diarrhea, skin and uti
 Bug spray with 30% DEET. For use in tropical areas where mosquitoes present, and yellow fever,
  denque and Rift valley fever occur.
  For areas where malaria occurs, bring antimalarial as well. Malaronehas less side effects than Lariam.
 Antihistamines and epinephrine for allergies. (In our case we take along an up to date rx of Medrol due to Amos' case of  angioneurotic edema.
 Topical tooth pain reliever, such as Orajel
 Pain relievers: Tylenol for minor pain, and because Amos has had ureteral calculi (kidney stones) we travel with Tylenol #3 and Demerol
 Dramamine for motion sickness.
 Acetazolamide for altitude sickness prevention.
 Hyperdermic syringes. Many countries in developing areas reuse needles, something you would like to avoid. To avoid security problems pack them in a first aid kit in your checked luggage and include note from physician.
 Waterless soap or premoistened towelettes. For cleaning hands or wounds without water.
 Bandages, tapes, gauze, antibiotic ointment, hydrocortisone, moleskin. To treat minor scrapes and blisters.
 Thermometer to gauge severity of illness.
 Pocketknife, nail clipper. Handy for removing splinters. Transport in checked luggage.
 International Certificate of vaccination. Required for entry into certain countries.
 Sunscreen. Always necessary.
 Voltage changer for Europe.
 Small reading light that clips to book or where electric lights will be dim, a small head lamp.
 copies of addresses and telephone numbers that might be needed.
 copies of front page of passport
copies of credit cards I take with numbers  to call to cancel
 AAA card number
 a single check
 Travelers' checks  with copies of numbers kept separately in at least two places in your bags

money belt
suntan lotion
inflatable neck pillow
inflatable bed pillow (useful also on the airplane.)
insect repellent
2 decks of cards
Echinacea tea
blister band aids
portable hair curling iron
set of travel makeup
pillboxes, enough for trip plus 2 weeks
mask for sleep
pantie liners
Travel alarm
Birding book for area
ear plugs
5-6 slacks
1-2 dressier outfits
7-8 tops
2-3 pairs of shoes
underwear, possibly quick dry underwear designed for travel (they dry in 2-3 hours)
socks and hose
Meds with copies of current prescriptions
Insulin and syringes, glucose monitor.

And here is a second list which lists some other things I often take. it is called The Universal Packing List. (UPL)

The UPL is Copyright Mats Henricson, 1993-2007. The UPL is for private non-commercial use. For other purposes, please contact Mats. Mats is also asking for donations if you like this list and it is also configurable. By answering various descriptive terms about your trip this long list is customized to your specific travel plans.  The configurable list is at this site. Most of the entire list is below.

Things to do before you leave:

To do for most trips:
Wash the dishes
Make a lunch
Pet Care
Empty all trash cans
Confirm airline tickets
Get your air miles in advance
Order special air meals
Memorize PIN codes to credit cards
Check out what hospitals are covered by your health insurance
Get travel insurance
Change money
Install or recharge batteries
Get maps
Forward (or hold) delivery of newspapers and magazines

To do for longer trips:
Balance your bank account
Wash clothes
Clean out your flat
Forward your email
Pay the rent and other necessary bills
Arrange plant care
Empty all water containers
Store away things that are easy to steal
Empty your fridge of perishables
Give copies of your keys to someone else
Fill in the tax return form
Hold delivery of snail mail
Change Of Address ( COA )

Core vaccinations:
Typhus vaccination
Typhoid vaccination
Polio vaccination
Tetanus vaccination
Destination specific vaccinations such as:
Yellow Fever vaccination
Cholera vaccination
Hepatitis vaccination
Plague vaccination
Meningitis vaccination
Japanese B Encephalitis vaccination

What to Take Along:
Unisex clothes
Trousers ( Pants, Jeans )
Cap ( Hat )

Clothes for women:
Walking shoes
Sandals ( Flip-flops )

Optional clothes:
Swimming trunks ( Bikini )
Beach pants
Jewelry (I usually take very little, and not my expensive stuff)

Clothes for Cold weather:
Jacket ( Wind breaker )
Long underwear
Knitted (woolen) cap

Money and documents:
Basic documents:
Vaccination certificate
Insurance certificate ( Health Insurance card )
Paper from your local social insurance office
Travel cheques
Receipt for travellers' cheques
Emergency money
Credit/ATM cards ( Visa, Eurocard/Mastercard, American Express etc )
Driver's license
ID card
Address list (with phone numbers and email addresses)

Optional documents:
This packing list

Photocopies of passport and other important documents:
International Student Identification Card ( ISIC )
Tourist organization certificate
Photographs for visas/passports etc
Addresses and phone numbers to embassies
Phone card
Membership cards
Neckbag for carrying money and documents
Pouch for valuable documents
Money belt
Paper folder
Clothes with hidden pockets
Airline tickets
Maps:  Small scale map,  Large scale map


Things for packing:
Small extra backpack ( Knap sack, Day pack )
Expandable carry-on
Plastic bags ( Ziploc )
Stuff Sack
Small box
Luggage belt

Eating equipment:
Swiss army knife
Multi-tool ( Folding knife )
Cork screw

Miscellaneous equipment:

Extra things:
Safety pins
Sewing Kit
Sturdy nylon cord ( Clothes line )
Cable ties ( Zip ties )

Toilet bag ( Bathroom bag, Necessaire )
Extra blades for Razor
Shaving gel ( Shaving foam )
Electric shaver
Styling gel ( Hair gel )
Sunblock lotion
Extra glasses

Hygiene (women only):
Medication against yeast infection

Hygiene (optional):
Comb and/or Hair brush
Laundry bag


General health items:
Prescription medicine
Sore tape ( Adhesive tape )
Insect repellent
Band-Aids ( Plaster )
First aid kit
Water bottle
Water purifying filter
Chewing gum
Disposable syringes
Pills, tablets and medicines
Water purifying tablets
Motion sickness tablets
Jetlag tablets (melatonin)
Contraceptive tablets
Fever tablets
Pain relievers
Allergy pills ( Anti-histamines )
Malaria tablets
Diarrhea medicine

Electrical stuff:
General electrical items
Cell Phone ( Mobile Phone, Cellular Phone )
Charger to Cell Phone
ComputerWall socket adapter
Flashlight ( Torch )
Music items
Music player ( Cassette, CD, MiniDisc, MP3 )
Music media ( Music cassettes, CDs )
Small battery operated personal fan (I added this one)

     And that is the end!! Of course if you packed all of these items you wouldn't even be able to get into the cab to the airport with all of your luggage. Each trip is different and you will have different needs. You must read about your trip -- the US State Department's recommendations and forums or websites about your destination, as well as whatever your tour guides or tour companies have provided. They know best what you will need where you are going. For example, motion sickness pills were recommended for a trip to Kenya and Tanzania -- the interior, not the sea. Now after being on those roads I see why they were listed. In those two countries we lived in those khaki zip off pants that convert into shorts. But I have read that in some countries you don't want to wear these convenient clothes because they mark you as a tourist and therefore an easy mark where crime is high. So read, read and read some more!

I generally go over these two lists and check them against what I have put aside to pack. There is some duplication but I like to use both of them. Feel free to borrow these for your next trip. They really help me, though I still drive out of the driveway wondering what it is that I forgot even after all of this. Venture out. The world is a wonderful and fascinating place. Happy traveling!!

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