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Several risks can be posed by travel, even when the stay is not protracted nor the destination exotic. Air travelers should consider the potential problems associated with decreased cabin pressure, hypoxia, and circadian dysrhythmia, problems that can contraindicate flying for some. Motion sickness can affect those traveling by air, sea, or land; medications are available to combat the symptoms, and several other remedies such as changing visual stimuli are also worth trying. Persons staying in hotels, particularly high rises, should review several general guidelines for defensive action in case of fire and should become familiar with the physical layout and escape routes of the building in which they are staying.

Various medical conditions--cardiovascular and pulmonary problems, thrombosis, diabetes, and others--can present special risks and/or problems in travel. These should be discussed as part of a thorough predeparture evaluation with affected patients who are planning overseas travel. In addition, certain travelers may require medical follow-up on their return. Various travel medicine resource organizations, booklets, and books should be made known to all travelers.

Physicians counseling patients who are planning major travels should make sure that baseline immunizations (diphtheria-tetanus-pertussis, polio, measles, rubella) and any necessary boosters are current. In addition, several other immunizations may be warranted (yellow fever, typhoid, and cholera), depending on destination(s) and itinerary, and prophylaxis for malaria may be advisable. As worldwide requirements for immunization do change, the physician should verify current requirements before planning an immunization schedule for a particular patient.

In view of all the controversy surrounding travelers' diarrhea, how should patients be counseled regarding its prevention and treatment? First, all patients should be instructed on the importance of eating and drinking only safe food and water and on methods of dietary manipulation and oral rehydration therapy. The travelers listed in table 4, as well as short-term visitors to Mexico, may be candidates for prophylactic medication unless such treatment is contraindicated. All patients can be offered an antimotility agent for discriminant use as discussed, and a prescription for trimethoprim-sulfamethoxazole is generally a good idea in the event of a severe bout of illness during travel. A traveler can go overboard in an attempt to avoid diarrheal illness. Such overconcern can detract from the enjoyment of travel and limit the spectrum of activities and cuisine. One report noted that diarrhea seemed to occur more frequently the more a traveler tried to elude it! This could well set the stage for the biggest controversy of all.