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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18461
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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We are considering a business trip to Bangkok, Thailand in

Resolved Question:

We are considering a business trip to Bangkok, Thailand in June 2014. My husband will be 73, suffers from diabetes, had a TIA in June 2013, is on metformin, ramipril, clopidogrel, Gabapentin daily and once a week takes Rosuvastatin. He is also prone to urine infections and cellulitis.

Would you consider this trip a health risk?

thank you
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. D. Love replied 3 years ago.
Does he have any difficulty in daily activities, such as walking?
When you say that he is prone to urine infections and cellulitis, how often does this happen?
Where is the cellulitis? Is it in the legs?
How bad are the symptoms associated with these infections?

Customer: replied 3 years ago.

He has difficulty walking but this is a longstanding and ongoing problem and partly due to very flat feet and an inability to obtain correct orthopaedic advice. Gapapentin alleviates pain.


Cellulitis in his left leg, had very bad infection in 2002 and occasional bouts since, last one in October after tripping over a pavement and cutting his leg. Is aware now of symptoms and gets treatment as soon as he can.


Urine infections probably two or three in last 12 months

Expert:  Dr. D. Love replied 3 years ago.
Thank you for the additional information.

There is some risk of developing a blood clot in a deep vein of the leg from a long distance air flight for everyone, but the risk is greater for people with pre-existing risk factors for forming venous blood clots. The medical conditions and medicines that you list do not create a pre-existing risk for forming venous blood clots, unless they impair mobility. Limited mobility is one of the risk factors for forming venous blood clot. In addition, one of the primary protections against forming blood clots is to get up and walk as much as possible during the flight. Recurrent cellulitis in the legs also could represent a risk factor, because one of the risk factors is poor venous flow from the legs, which is also a risk factor for developing cellulitis of the leg. The history of cellulitis is not an issue, only that there may be underlying poor venous flow.

Even with limited mobility or poor venous flow, the vast majority of people do not develop a venous blood clot during travel. Precise measurements of risk vary significantly, but is probably in the range of 0.3 - 0.5%, with some estimates of risk being even lower. This is usually not at a level that it is recommended to avoid plane flights, but there is sufficient risk that it is recommended that people with risk factors wear medical compression stockings during long plane flights.

The medical conditions also do not pose significant risk for the heat, as long as he stays hydrated. Diabetes, and particularly poorly controlled diabetes, tends to cause an increased loss of fluids, and additional fluid loss from heat can cause dehydration. But if he intentionally drinks plenty of hydrating fluids, then this risk can be avoided.

If you have any further questions or need clarification, please let me know.

Expert:  Dr. D. Love replied 3 years ago.

I do not see that you have received or reviewed the answer that I provided above. Sometimes, the notification system fails, so I am placing another post to prompt the system to send another notification. My answer is as above. If you have any further questions, please let me know.

Customer: replied 3 years ago.

Sorry for the delay in getting back to you - I had to leave the house at 10.30 a.m. for a previous engagement.


 


Thank you for your answer - I must admit my reason for asking the question was to get a negative response about the journey and heat in an attempt to persuade him not to go!


 


He's very bad at keeping himself hydrated at the best of times, so I was hoping your response might highlight the risk of urine infections as well as mosquito bites that could bring on cellulitis.


 


Can you help in this regard?


 


thank you again


 


Marilynne

Expert:  Dr. D. Love replied 3 years ago.
There is a long list of possible complications from dehydration, but the concern about possible urine infections is both low on the list and one of the least of our worries, since urine infections are so easily treated. Complications that are more of a concern would include swelling of the brain, seizures, electrolyte disurbances (which can cause heart problems/arrhythmias), kidney failure, shock, coma, or death.

As I said above, good fluid intake is important to avoid the risk of dehydration, but if he is not good at maintaining fluid intake, then that would increase the risk of dehydration, which is far more of a concern than the possibility of exacerbating a urine infection. This also would be a far greater risk than the risk associated with mosquito bites contributing to the possibility of a recurrence of cellulitis.

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