TAP Air Portugal now offers all passengers COVID-19 testing service at Lisbon Airport at a discount. Depending on a destination’s various restrictions, the Rapid Antigen Test is €21; the PCR test is €85; and a PCR Test plus Rapid Antigen Test is €106. TAP customers enjoy priority access to this service.
FORGETTING MEDICATION WHILE traveling is an inconvenience in the best of circumstances. If you use a retail chain pharmacy like CVS or Walmart in the United States and are traveling domestically, the same chain pharmacy can internally transfer your prescription to get it filled in the state you are visiting, or the pharmacist may be able to give you a few pills to hold you over during your stay.
WHEN TRAVELING WITH FAMILY or friends who become ill, you may have to advocate for them to receive the best health care or have their concerns taken seriously. Or you may need a health advocate yourself. A health advocate is a family member, friend, trusted co-worker or a hired professional who can ask questions, write down information and speak up for you so you can better understand your illness and receive the care and treatment you need, giving you peace of mind so you can focus on your recovery.
ADULT ATTENTION-DEFICIT/HYPERACTIVITY disorder is a mental health disorder that presents a combination of persistent problems such as distractibility, hyperactivity and impulsive behavior. Adult ADHD can lead to unstable relationships, poor work or school performance, low self-esteem and other problems. ADHD can make life difficult and has been linked to unemployment, financial problems, trouble with the law and alcohol or other substance abuse. Frequent car accidents or other accidents, poor physical and mental health and suicide attempts may also be associated with ADHD.
MULTIPLE SCLEROSIS is an autoimmune disease that damages the nerves in the spinal cord and brain as well as the optic nerves. MS affects women more than men. The disorder is most commonly diagnosed between ages 20 and 40 but can be seen at any age. MS damages the myelin sheath, the protective covering surrounding the nerve cells, causing nerve signals to slow or stop.
NO MATTER HOW EXPERIENCED a traveler you are, at some point in your journeys you will become sick, get cut or have a digestive disturbance. Granted, you could call the hotel front desk, the concierge or the hotel doctor for help (if there is one). You could try to locate a pharmacy in a new, unfamiliar city. It is so much easier to head back to your hotel room to obtain your favorite remedy for your illness. This avoids searching for help during late-night hours, going to a pharmacy and facing language barriers and confusion with brand names that may be familiar to you. Before you leave home, pack these 10 items to help you through typical travel ailments. However, be aware some countries ban certain over-the-counter medications; always check regulations before traveling.
THE FLU, ALSO KNOW AS INFLUENZA, is a respiratory infection caused by several viruses. The viruses pass through the air and enter your body through your nose or mouth. Between 5 and 20 percent of the U.S. population gets the flu each year. The flu can be serious or even deadly for elderly people, newborn babies, young children and individuals with certain chronic illnesses. The best way to prevent flu is by getting a flu vaccine each year.
BELL’S PALSY IS A NERVE DISORDER that usually occurs without warning. This condition happens when the nerve that controls facial muscle movement becomes swollen, inflamed or compressed. Damage to this nerve — called the facial nerve or the seventh cranial nerve — causes weakness and paralysis of facial muscles.
CHRONIC FATIGUE SYNDROME, or CFS, is a complex chronic disease afflicting 1 million Americans. Also referred to as myalgic encephalomyelitis (ME or ME/CFS), this long-term illness affects many body systems. Individuals with this illness are unable to perform daily activities and may be confined to bed. Women are two to four times more likely than men to be diagnosed with ME/CFS.
IF YOU ARE A TRAVELER WHO LIKES to cruise, try something different — a healthy living cruise. Many travelers associate cruise vacations with unhealthy activities such as excessive drinking, partying and all-you-can-eat buffets served around the clock. This has been the stereotype for cruising for many years. However, the tide is turning for cruises as many travelers now look for healthier alternatives.
A SEIZURE IS THE PHYSICAL changes in behavior after an episode of abnormal electrical activity in the brain. The term “seizure” is often used interchangeably with “convulsion.” During convulsions, a person experiences uncontrollable rapid and rhythmic shaking, with the muscles contracting and relaxing repeatedly. There are many types of seizures. Some have mild symptoms without shaking.
COPD STANDS FOR CHRONIC obstructive pulmonary disease, which results in blocked airways in the lungs, making it hard to breathe. Over time, symptoms usually worsen, making it more difficult to take care of yourself and take part in activities. Chronic bronchitis and emphysema are two common types of COPD.
STRONG, HEALTHY RELATIONSHIPS are vital throughout our lives. Our social ties with family, friends, neighbors, co-workers and others impact our mental, emotional and even physical well-being. Healthy relationships are powerful in promoting overall health. Research shows having a variety of social relationships may help reduce stress and heart-related risks. Strong social ties are linked to a longer life, while loneliness and social isolation are linked to poorer health, depression and increased risk of an early death.
ENTEROVIRUSES ARE VIRUSES that enter the body through the gastrointestinal tract and live there, often moving on to attack the nervous system. These viruses are small, made up of ribonucleic acid and protein. The polioviruses are enteroviruses. In addition to the three different polio viruses, there are non-polio enteroviruses that can cause disease in humans, including coxsackieviruses and echoviruses.
MEDICATIONS IN PILL or other solid form must undergo security screening at U.S. airports. The Transportation Security Administration recommends medication be clearly labeled to speed up the screening process. Check with state laws regarding prescription medication labels. It is best to keep your medications in their own individual prescription bottles from the pharmacy.
TO ENSURE OUR SECURITY, all travelers are required to undergo Transportation Security Administration screening at the airport checkpoint. Screening is intended to prevent prohibited items and other threats to transportation security from entering the sterile area of the airport and are developed in response to information on threats. TSA uses unpredictable security measures throughout the airport, and no individual, including those with medical conditions, is guaranteed expedited screening.
YOU MAY NOT THINK ABOUT diseases as you prepare for your next trip, but your health is at risk in many destinations. To stay safe, make sure you and your family are current on vaccinations. Each year, unvaccinated travelers become infected while in other countries, bringing the disease into the United States and spreading it to others.
DESPITE ITS NAME, VITAMIN D is a prohormone and not a vitamin. Vitamins are nutrients our bodies cannot create which we must obtain through diet and supplements. Our bodies can synthesize vitamin D when sunlight hits the skin. We need vitamin D to aid the absorption of calcium and phosphorous by the bones and teeth, making bones stronger.
PNEUMONIA, AN INFECTION that inflames the air sacs of one or both lungs, affects millions of Americans each year. The air sacs, or alveoli, are where the oxygenation of the blood occurs. The alveoli may fill with fluid or pus, causing a cough with phlegm or pus. Pneumonia can range from mild to life-threatening and is most serious in infants, young children, people older than 65 and people with health problems or weakened immune systems.
FOR PEOPLE WITH DISABILITIES, travel is easier than ever. It just takes time to research and plan your trip. Each country has its own standards of accessibility for persons with disabilities, so the more research you do, the more accessible and pleasant your trip will be. Your vacation or business trip can be filled with accessible hotel accommodations, accessible routes between tourist attractions and wonderful experiences.
AT ONE TIME OR ANOTHER, nearly everyone experiences indigestion (dyspepsia), a feeling of discomfort or burning in your upper abdomen. You may belch and feel bloated. You may also feel nauseated or even vomit. Although indigestion is common, each person experiences it in a slightly different way, with symptoms occurring only occasionally or as often as daily. It is bad enough to have indigestion at home; you certainly want to avoid it while traveling, though sticking to your normally healthy diet of fruits, vegetables, whole grains and lean proteins is not always a priority or even a possibility.
WATER IS ESSENTIAL FOR LIFE. Approximately 60 percent of the human body is made of water. The brain and heart are composed of 73 percent water while the lungs are about 83 percent. Water is simple and, one hopes, pure. We often take it for granted until we are in a situation where fresh drinking water is scarce or unavailable.
AS YOU PLAN YOUR NEXT TRIP, consider using mobile apps to navigate safe passage. You can find plenty of travel health apps on the App Store for iOS devices and on Google Play for Android devices. All apps mentioned here are free unless a cost is noted.
WHILE BABIES AND CHILDREN can be infected with Zika through the bites of two types of mosquitoes, no cases of Zika have been reported as a result of breastfeeding. Because of the benefits, mothers are encouraged to breastfeed even in areas where Zika virus is found.
DRUG-RESISTANT GONORRHEA poses an urgent threat worldwide. While about 820,000 new gonorrhea infections are detected yearly in the United States, less than half are reported to the Centers for Disease Control and Prevention. At least 240,000 cases are found to be resistant to at least one antibiotic usually prescribed to treat the disease. In fact, Neisseria gonorrhoeae, the bacteria that cause gonorrhea, developed resistance to nearly all of the antibiotics used for treatment: sulfonilamides, penicillin, tetracycline and fluoroquinolones. There is one last effective class of antibiotics, cephalosporins, to treat this common, sexually transmitted disease.
CAT-SCRATCH DISEASE, or CSD, is spread by cats to humans. It is a bacterial infection caused by the bacterium Bartonella henselae, found worldwide. The incidence of CSD appears to have a seasonal relationship, possibly due to the mating behavior of the cat flea during certain times of the year.
PARACETAMOL, ALSO KNOWN as acetaminophen, is a popular medication sold in the United States under the brand name Tylenol and in other countries as Panadol. It is in a class of medications called analgesics (pain relievers) and antipyretics (fever reducers) and works by changing the way the body senses pain and by cooling the body. It is used to reduce fever and to relieve mild to moderate pain from headaches, muscle aches, menstrual periods, colds, sore throats, toothaches, backaches and reactions to vaccinations. It may also relieve the pain of mild osteoarthritis (arthritis caused by the breakdown of the lining of the joints).
GLAUCOMA IS AN EYE DISEASE that can cause blindness. If caught early, it can usually be treated and controlled. Because glaucoma often has no symptoms, however, it is important to have yearly eye exams. Glaucoma begins when pressure builds up in the eye. This intraocular pressure can damage the optic nerve, which sends messages to the brain so we can see.
IN JANUARY 1943 my mother traveled by train with my 6-week-old brother to visit my father, a U.S. Navy officer stationed in Oklahoma teaching flight using blimps. Many passengers asked to hold the baby, but she only allowed another woman to take him while she used the ladies’ room. She feared the baby would contract an illness from a stranger or someone would take him.
In 1971 the first email was sent between two computers situated side by side, but it took decades and the development of the internet before its widespread use. In 1994 Geocities, the first social networking site, allowed users to create their own websites. The following year TheGlobe.com gave users the ability to interact with people with the same interests and to publish their own content. And so social media was born.
You arrive at your hotel after a long flight, pleased to learn your room is ready. You head to the room and collapse, exhausted, on the bed, only to sense a strong antiseptic smell. You hope the scent goes away soon, but you wonder: How safe for your health are the products used to clean your guestroom and bathroom?
World Mosquito Day, observed every Aug. 20, commemorates Sir Donald Ross, the British medical researcher who discovered the mechanism of malaria transmission. His discovery laid the foundations for scientists around the world to better understand the deadly role of mosquitoes in disease transmission and to come up with effective, innovative interventions. Sir Ross received the Nobel Prize for Medicine for his work on malaria in 1902. Our understanding of the mosquito vector and its role in transmitting malaria and yellow fever — and now, of global importance, dengue, chikungunya and Zika — transformed our world. About 1,500 cases of malaria are diagnosed in the United States each year, the vast majority of the cases in travelers and immigrants returning from parts of the world where malaria transmission occurs, including sub-Saharan Africa and South Asia. The World Health Organization estimates 214 million clinical cases of malaria occurred globally in 2015 and 438,000 people died of malaria, most of them children in Africa. Prevention is essential, and attempts at producing an effective vaccine and clinical trials are ongoing. Yellow fever is preventable by a relatively safe, effective vaccine. Yellow fever vaccine is recommended for people older than 9 months traveling to or living in areas with yellow fever virus transmission in South America or Africa. Some countries require visitors to provide proof of yellow fever vaccination. Contraindications to receiving this vaccine include infants younger than 6 months; people with a history of acute hypersensitivity reaction to any component in the vaccine such as eggs, egg products, chicken proteins or gelatin; and those with altered immune status, HIV or AIDS. Dengue fever is prevalent in at least 100 countries in Asia, the Pacific, the Americas, Africa and the Caribbean. The WHO estimates 50 to 100 million dengue infections occur yearly, including 500,000 dengue hemorrhagic fever cases and 22,000 deaths, mostly in children. Nearly all dengue cases reported in the 48 contiguous United States were acquired elsewhere by travelers or immigrants. There is no vaccine for dengue fever. Outbreaks of chikungunya virus occurred in parts of Africa, Europe, Southeast Asia and the islands of the Indian and Pacific oceans. It was found in the Americas in 2013 and spread to the Caribbean and South, Central and North America. No vaccine to prevent or medicine to treat infection is available. The mosquitoes that spread chikungunya bite aggressively during the day. Pregnant women should strictly follow steps to prevent mosquito bites while traveling, as Zika infection in a pregnant woman is linked to serious birth defects and miscarriage. The Centers for Disease Control and Prevention recommend pregnant women not travel to areas with Zika outbreaks. There is no vaccine or medicine, and it can be passed from an infected man during unprotected sex. This is preventable by using condoms the right way every time during all types of sex. To date there is no evidence of transmission from a woman during sex. Reduce your risk by taking steps to prevent bites. Use EPA-registered insect repellent that contain at least 20 percent DEET for protection against mosquitoes. Use Picaridin or products that contain oil of lemon eucalyptus (OLE) or para-menthane-diol (PMD). The effectiveness of insect repellents not registered with the EPA, including some natural repellents, is not known. When using repellent, follow the package instructions and reapply as directed. In general, higher percentages of the active ingredient provide longer-lasting protection. However, this increase in protection time maximizes at about 50 percent DEET. If you are also using sunscreen, apply it first, let it dry, then apply repellent. Do not use products containing both sunscreen and repellent. Do not spray repellent on the skin under clothing. Consider using clothing and gear treated with permethrin, an insecticide. Buy pre-treated clothes or treat your own clothes, following instructions carefully. Do not use permethrin directly on skin. Wear long-sleeved shirts, long pants, socks and a hat. Tuck your shirt into your pants, and tuck your pants into your socks for maximum protection. Choose accommodations that are air-conditioned or have good window and door screens. If mosquitoes can get into your sleeping area, sleep under a permethrin-treated bed net that can be tucked under the mattress. When outdoors, use area repellents such as mosquito coils containing metofluthrin or allethrin. Do not use insect repellents on babies younger than 2 months. Do not use products containing OLE or PMD on children younger than 3 years. Children should not touch repellent. Adults should apply it to their own hands and gently spread it over the child’s exposed skin. Do not apply repellent to children’s hands because they tend to put their hands in their mouths. Keep repellent out of the reach of children. Protect babies younger than 2 months by draping mosquito netting over their carrier or car seat; netting should have an elastic edge for a tight fit. When used as directed, EPA-registered insect repellents are safe and effective for pregnant and breastfeeding women. The content of this article is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition.
Before you travel internationally, ensure you are up to date on all routine immunizations as well as travel vaccines. Vaccines are available to prevent 25 life-threatening diseases, and 24 of them are administered in the United States. Vaccinations may hurt a little, but the diseases they prevent are a lot worse, some even life-threatening. Immunization shots are essential, protecting against diseases like measles, mumps, rubella, hepatitis B, polio, tetanus, diphtheria and pertussis (whooping cough). Some people think only infants and children need vaccines, but it is important for adults to receive them as well.
When packing for a trip outside the United States, you must consider how to handle health conditions that require medications. Talk with your provider and prescription insurance company before you travel. Many online resources also provide advice for traveling with medications. Be a good consumer of this information and check the facts so you will be prepared. It is important to carry your medications with you at all times. Do not place medications in checked baggage; pack them in your carry-on. If you are traveling with someone else, split the medication to minimize loss or theft. Bring enough medication to last your whole trip plus a few days extra in case you are delayed. If you use equipment such as syringes or needles, pack your own sterile supply along with a written prescription for them from your health care provider. Filling a prescription abroad can be complicated. Keep your medication in its original container from the pharmacy and be sure it is clearly labeled. Use pill boxes to carry small amounts needed during the course of the day. Learn how to safely store medications and check if they require refrigeration. Use insulated wallets and containers during transit. Ask your pharmacist for recommendations and make arrangements at your destination for safe storage. Extreme heat also impacts a medication’s effectiveness. If customs officials question you or if an emergency arises, it will be helpful to have a typed statement from your medical provider (on letterhead with his or her name, address and contact information) describing your medical history, condition and the medication you are taking. Let your pharmacist know you are taking medications out of the country. Bring a copy or two of original prescription information, including generic and foreign brand names. Those who require long-term medications such as insulin or have a medical condition and treatment wishes should consider wearing a medical alert bracelet, necklace or similar alert tag at all times. If an accident occurs and the traveler is too ill to communicate, a medical alert tag helps responders provide appropriate care. The tag should also contain the reason the medication is needed, as well as the name and phone number of an emergency contact. Travelers with life-threatening allergies to medications, food or insect bites should also wear a medical alert tag. It may not be the coolest piece of jewelry, but it could save your life. If you require epinephrine to treat your allergic reactions, bring your own EpiPen with a prescription for its use. You can adjust to time zone changes by gradually changing your medication schedule while in transit, or change to a new schedule after arriving in a new time zone. Your health care provider and experienced travelers with similar conditions can provide insight on these adjustments. If you are feeling better, do not stop taking or change the dosage of a regular medication without the consultation and supervision of a professional. Embassies can recommend appropriate medical professionals to provide medical support in the location where you will be staying. For information, contact U.S. embassies or the International Association for Medical Assistance to Travellers. Some U.S. prescriptions are illegal in other countries and may render you subject to arrest. Check with the foreign embassy of the country you are visiting or transiting in to make sure your medications are not considered illegal narcotics. Be aware of medications for potential abuse such as anabolic steroids. Two classes of medicines, narcotics and psychotropics, come under the authority of international law. This covers any medicine that has an effect on the central nervous system and has the potential to be abused. The narcotic class mostly relates to analgesic opioids and their derivatives, which tend to be highly regulated. Psychotropics are used to treat mental disorders such as anxiety, depression and psychotic conditions. Be wary of carrying any medicine with the potential to affect the central nervous system. Some countries include a range of medications used to treat neurological conditions such as epilepsy and Parkinson’s disease on their regulated list. Others might even include sedating antihistamines as a banned substance. A few countries such as the United Arab Emirates include a range of non-CNS items. To review the international agreements governing the transportation of medications across borders, check with the International Narcotics Control Board, an independent, quasi-judicial group responsible for international drug control. NCB guidelines state people intending to travel with narcotics and psychotropics should be allowed to carry quantities of such substances for personal use, usually for use of up to one month, and that travelers have a letter or prescription from their doctor if traveling with a narcotic substance. The board also advises it may be illegal to send some prescription medications through the mail. Check with the postal service and customs office before doing so. If mailing a medication is permitted, be wary, as it may be delayed, damaged, lost or opened, so have a back-up plan. The content of this article is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition.
Life-threatening illnesses may be chronic diseases people learn to live with while trying to lead a “normal” life. The top such diseases include coronary artery disease (CAD); ischemic heart disease or stroke; transient ischemic attack (TIA); chronic obstructive pulmonary disease (COPD); lower respiratory infections; cancers of the trachea, bronchia or lungs; HIV/AIDS; diabetes; diarrheal diseases; and tuberculosis. The list also includes deadly allergic reactions. Traveling with one or more of these diseases requires a preliminary discussion with your health care provider and approval for you to travel. Have your provider examine you from head to toe. Key elements of this risk assessment include the pre-travel health status of the traveler, destinations, duration and purpose of travel, the mode of transport, standards of accommodation, food hygiene and risk behavior before traveling. This information is necessary to determine which vaccinations need to be administered prior to your trip. Depending on the illness, get approval for travel from your medical specialist such as a cardiologist, pulmonologist, neurologist, oncologist or endocrinologist. See your dentist to make sure your teeth are in good health and free from infection, inflammation or pain. Think and plan ahead for all that could possibly occur due to your condition and be prepared for it. Research the availability of medical services in the destination, prophylaxis, emergency treatment kits, access to emergency care and self-treatment kits to take care of such risks as traveler’s diarrhea. Purchase travel insurance including travel health insurance with appropriate coverage abroad in case of accident or sickness and medical evacuation insurance for emergency transport back to the United States. Bring a list of your medical conditions, chronic illnesses, medical treatment, medications, allergies and mental health history. Enter physicians’ names and phone numbers in the United States on your cellphone, laptop or jump drive. Travelers should carry copies of all prescriptions including generic names, preferably translated into the local language of the destination. For controlled substances and injectable medications, travelers should carry a note on letterhead from the prescribing physician or travel clinic. Certain medications are not permitted in some countries. If you have a question about restrictions, contact the embassy or consulate of the designated country. The U.S. Embassy can also help. People with preexisting conditions such as diabetes or allergies should consider wearing a medical alert bracelet and make sure this information is on a card in their wallet and with other travel documents. Diabetics need to have a generous supply of medications, needles and syringes, testing supplies, blood glucose monitor (available with a prescription) and a letter on their provider’s letterhead indicating all items. Travelers with a history of life-threatening allergic reactions should carry injectable epinephrine or auto-injectors of epinephrine such as the EpiPen 2-PAK, antihistamines and oral steroid medication at all times. These medications require a prescription. Keep medication accessible in your carry-on bag in labeled prescription bottles for clear identification. Pack enough medications for the duration of the trip plus an extra supply in case the trip is extended for any reason. Pack additional supplies such eyeglasses/contacts and their prescriptions or associated medications. Most people with medical conditions can fly safely provided they plan in advance for necessary precautions such as additional oxygen. The airline will supply oxygen for a fee, but you will need copies of your prescription for oxygen. Request additional oxygen for the airport to be delivered as you leave the aircraft. You must arrange to have oxygen delivered to your destination as well as for layovers during your flight. A frequent traveler with a permanent and stable underlying health problem or disability may obtain a frequent-traveler medical card from the medical or reservations department of many airlines. Airlines accept this card under specified conditions as proof of medical clearance and identification of the medical condition. Security checks can cause concern for travelers fitted with metal devices such as artificial joints, pacemakers or internal automatic defibrillators. Some pacemakers may be affected by modern security screening equipment. Any traveler with a pacemaker should carry a letter on letterhead from the cardiologist. Automatic external defibrillators (AED) are located throughout airports and on many planes. Check with your airline to see if it stocks one on each plane and if the staff know how to use it. If you have experienced sudden cardiac arrest, you may want to carry your own AED and travel with someone who knows how to use it and knows CPR. Many airlines have facilities to enable crew to contact a medical expert at a ground-based response center for advice on how to manage in-flight medical emergencies. The Centers for Disease Control and Prevention recommend travelers keep current on standard immunizations; inquire about other vaccinations or preventive medications; avoid insect bites; wear shoes when outside; follow precautions regarding food and drinking water; avoid animals and seek immediate care if bitten; practice safe sex, using condoms; and have a medical check-up upon returning home if they became ill while away. The content of this article is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition.
Medical tourism — sometimes referred to as health tourism, medical outsourcing or medical travel — has a long history. Explorers from all over the world once traveled to the healing temples of ancient Greece to seek cures for their ailments. In Western culture, pilgrims journeyed to the healing waters of Bath in England or the holy waters of Lourdes, France. Today, the net worth of the health tourism industry is estimated at $40 billion. Leading medical tourism locations span the globe and include Brazil, Costa Rica, India, Malaysia, Mexico, Singapore, Taiwan, Thailand and Turkey.
The United States pays the highest prices in the world for prescription medications, and the majority of Americans (72 percent) believe these costs are unreasonable. According to the International Federation of Health Plans, Americans pay two to six times more than the rest of the world for brand-name prescription drugs. Specialty and cancer drugs tend to be the most expensive, but commonly used medications also carry sky-high prices.
One-third to one-half of all Americans experience insomnia and complain of poor sleep. Insomnia can occur during times of stress, travel and other disruptions. If you regularly have difficulty sleeping, make an appointment with your health care provider. Treatment depends on the cause of your insomnia. Some people who have difficulty falling asleep and staying asleep need medications to help with sleep for a short period. Sometimes an underlying medical disorder or sleep disorder is discovered and treated.
Cellulitis is a spreading bacterial infection in the deepest layers of the skin and soft tissue. Staphylococcus and streptococcus bacteria are the most common cause. Many types of bacteria normally live on skin, but they can enter and cause infection when there is a break in the skin. When cellulitis develops without an apparent skin injury, it may be due to microscopic cracks (fissures) in the skin that are inflamed or irritated.
Attention deficit hyperactivity disorder is a common childhood brain disorder which can persist through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, a struggle to control behavior and hyperactivity, making it hard for a child to do well in school or behave. Children and adults from all backgrounds can have ADHD.
Viral hepatitis is inflammation of the liver caused by viruses. Other infections, toxic substances such as alcohol, certain drugs, drug abuse and autoimmune diseases also cause the disease. Hepatitis can be self-limiting or can progress to fibrosis, cirrhosis or liver cancer.
Pneumococcal disease is the leading cause of serious illness throughout the world, caused by the Streptococcus pneumoniae bacterium. The bacterium spreads through contact with people who are ill or by healthy people who carry it in the back of their nose or throat. In developing countries, pneumococcus is linked to high infant and child mortality rates. Even in more industrialized countries, pneumococcal disease commonly occurs in adults and children. The World Health Organization estimates more than 1.6 million people — including 850,000 children younger than 5 years — die every year from pneumococcal infections. Nearly all these deaths occur in the poorest countries.
Chronic fatigue syndrome is a serious, complicated disorder causing debilitating fatigue, a continued tiredness not relieved by rest that is not directly caused by other medical conditions. It is also called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and chronic fatigue immune dysfunction syndrome (CFIDS).
Lightning is one of the most underrated severe weather hazards, killing about the same number of people as tornadoes and more than hurricanes. Lightning kills about 50 people in the United States and about 2,000 people worldwide each year, injuring hundreds more. Lightning can occur anywhere there is a thunderstorm, with the most frequent strikes in July.
Like gun powder, the electronic cigarette is a Chinese invention. Electronic cigarettes, also known as e-cigarettes or e-cigs, are battery-operated devices that deliver liquid nicotine, flavor and other chemicals inserted in cartridges. An atomizer heats the liquid into a vapor that is inhaled (called “vaping”) and creates a vapor cloud resembling tobacco smoke. Most e-cigarettes are manufactured to look like conventional cigarettes, cigars or pipes, including a glowing tip. Some resemble items such as pens, USB memory sticks or flash drives. The first e-cigarettes came out on the market in 2004.
Plague is a severe and potentially deadly bacterial infection which affects rodents, certain animals and humans. Caused by the bacterium Yersinia pestis, the disease cycles among wild rodents such as rats and spreads via their fleas. People are at risk if they are bitten by a flea carrying the bacteria from an infected rodent, if they are scratched or bitten by infected domestic cats or if they handle or skin infected animals such as prairie dogs, squirrels, rats and rabbits.
Scabies is an itchy skin condition caused by Sarcoptes scabiei, a microscopic burrowing mite. The scabies mite tunnels into the upper layer of the skin, where it lives and lays eggs. Scabies occurs worldwide and affects people of all races and social classes. It is contagious and spreads rapidly under crowded conditions where close body contact is frequent, with outbreaks often occurring in families, child day care centers, extended-care facilities, prisons, schools, college dorms and nursing homes.
Middle Eastern Respiratory Syndrome, or MERS, is a coronavirus respiratory infection first reported in Saudi Arabia in 2012. In general, human coronaviruses, first identified in the mid-1960s, cause mild to moderate illnesses of the upper respiratory tract. However, most confirmed cases of MERS develop severe, acute respiratory illness.
The chikungunya (pronounced chik-en-gun-ye) virus is transmitted to humans by mosquitoes that become infected when they feed on a person who has the virus, often causing large outbreaks. Originating in East Africa, chikungunya outbreaks commonly occur in Africa, Asia, Europe and the Indian and Pacific ocean regions. In late 2013, the first local transmission in the Americas was reported in the Caribbean.
Sixteen countries border the Mediterranean Sea, and although their cultures vary, common to all — especially Greece, Spain, southern Italy and southern France — is the Mediterranean diet. More than a regimen, the Mediterranean diet is a lifestyle of healthy eating, exercise, enjoying meals with family and friends, and moderate red wine consumption with meals.
Plantar fasciitis is a painful condition involving the thick band of tissue (fascia) on the bottom of the foot. The fascia connects the heel bone to the toes and creates the arch of the foot, working like a rubber band between the heel and the bones in the ball of the foot. A fascia that is short forms a high arch; if it is long, it creates a low arch or flat foot. A pad of fat in your heel covers the fascia to absorb the shock of walking.
In the United States, 19 million new sexually transmitted disease infections occur each year. Since half of these are among people ages 15–24, prevention is more important than ever. STDs affect men and women from all socioeconomic levels and add about $16 billion to U.S. health care costs each year. Although STDs are widespread, most people remain unaware of the risk and consequences.
Computer vision syndrome, or CVS, is strain on the eyes caused by using a computer or other digital technology for prolonged periods. The level of discomfort increases with the length of time spent looking at the screen. Symptoms include tired, burning or itching eyes; watery eyes; dry eyes; blurred or double vision; headache; back, neck or shoulder pain; increased sensitivity to light; and difficulty focusing. Although CVS does not cause permanent eye damage, the symptoms can affect performance at work and at home.
Escherichia coli bacteria are commonly found in the intestines of healthy people and animals. Although most types of E. coli are harmless, certain strains cause severe illness directly or by producing toxins. Some cause food poisoning and diarrhea, while others cause urinary tract infections, respiratory infections and other illnesses. E. coli enteritis, bacterial inflammation of the small intestine, is the most common cause of travelers’ diarrhea. A few strains such as E. coli O157:H7 release toxins that cause acute food poisoning with severe abdominal cramps, bloody diarrhea and vomiting.
Escherichia coli bacteria are commonly found in the intestines of healthy people and animals. Although most types of E. coli are harmless, certain strains cause severe illness directly or by producing toxins. Some cause food poisoning and diarrhea, while others cause urinary tract infections, respiratory infections and other illnesses. E. coli enteritis, bacterial inflammation of the small intestine, is the most common cause of travelers’ diarrhea. A few strains such as E. coli O157:H7 release toxins that cause acute food poisoning with severe abdominal cramps, bloody diarrhea and vomiting. E. coli bacteria get into food in many ways. During processing, meat and poultry can come into contact with normal bacteria from an animal’s intestines. Water used for growing or shipping may contain animal or human waste. Food may be handled unsafely during transport or during storage or preparation in grocery stores, restaurants and homes. People get food poisoning after eating or drinking food prepared by someone who did not wash their hands or who used unclean or cross-contaminated utensils, cutting boards or other tools. It can occur if dairy products or food containing mayonnaise are left out of the refrigerator too long, if frozen or refrigerated foods are not stored at the proper temperatures or not properly reheated, or if raw produce is not washed well. Bacteria can contaminate “risky” foods: undercooked eggs and meats; raw fish, especially oysters; non-pasteurized dairy products and juices; and water from a well or stream, or city or town water that has not been treated. Although not common, E. coli can spread person to person when someone does not wash their hands after a bowel movement and then touches objects or someone else’s hands. People at increased risk for infection are the very young and the very old, individuals with weakened immune systems and those who eat riskier foods. Symptoms usually appear 24–72 hours after exposure. The most common symptom is sudden, severe diarrhea that is often bloody. Other symptoms include fever, gas, loss of appetite, stomach cramping and vomiting. Rare symptoms include easily occurring bruising, pale skin, red or bloody urine and reduced amount of urine. To diagnose an E. coli infection, a health care provider performs a physical exam and may request a stool culture. Healthy adults usually recover from E. coli O157: H7 within a week. Young children and older adults can develop a life-threatening kidney failure called hemolytic uremic syndrome, or HUS. The goal of treatment is to make you feel better and avoid dehydration, including replacing fluids and electrolytes, managing diarrhea, controlling nausea and vomiting and getting rest. Most otherwise healthy adults receive care at home. Antibiotics are usually not administered. Use anti-diarrheal medications only if approved by your physician. If symptoms are severe, older adults and children may require hospitalization to receive intravenous fluids and electrolytes and supportive care.
Chickenpox is a contagious disease caused by the varicella-zoster virus, a member of the herpes family. It spreads easily through the air when infected people sneeze or cough, or through contact with an infected individual’s chickenpox blisters. Because chickenpox is so contagious, people who have never had chickenpox nor been vaccinated against it can become infected by being in a room with an infected person; however, momentary exposure is not likely to result in infection.
Tuberculosis is an airborne disease that causes more deaths than any other infectious disease, infecting about 2 billion people worldwide and 15 million in the United States. TB is caused by the bacterium Mycobacterium tuberculosis, which spreads when a person with TB of the lungs or throat coughs, sneezes, sings or talks. The bacterium can float in the air for several hours and can infect anyone who breathes in the contamination. TB is not spread by shaking someone’s hand, sharing food or drink, touching bed linens or toilet seats, sharing toothbrushes or kissing.
We often take our hearing for granted until it is affected. There are 38 million people in the United States who are partly or totally unable to hear sound in one or both ears. Hearing loss seems to be accepted as a part of aging, but the leading cause of hearing impairment is exposure to noise.
The knee provides stable support for the body. It is a hinge joint formed where the thigh bone (femur) meets the shin bone (tibia). Cartilage covers the ends of the femur and tibia and lines the back of the knee cap (patella), absorbing stress and allowing the knee to bend. Muscles power the knee and leg for movement. Tendons attach muscles to bone, and ligaments connect bones and brace the joint. When all the parts are healthy, our knees bend and straighten easily and rotate slightly, allowing us to walk, squat, climb steps and turn without pain. If any part is injured, the knee may hurt and not perform correctly.
In 2012, a fungal meningitis outbreak was linked to the New England Compounding Center in Framingham, Mass., where a steroid produced by the facility became contaminated. The Centers for Disease Control and Prevention identified 751 individuals in 20 states sickened by the contaminated injections, including 64 who died.
Street food is nothing new. In ancient Rome and in medieval towns and cities, much of the population had no cooking facilities and relied on food vendors. For today’s traveler, street vendors are not just a source of convenient, tasty and reasonably priced food, but they often provide a sense of adventure, a way to experience local cuisines.
Despite the availability of a safe, inexpensive and effective vaccine, measles remains the leading cause of death among young children globally. Each year, measles infects 20 million people worldwide. In 2011, there were 158,000 measles deaths globally — 430 a day, or 18 deaths every hour. Most were children younger than 5, and more than half of the deaths occurred in India. About 95 percent of measles deaths occur in low-income countries without vaccination programs.
Heart disease is still the No. 1 killer of men and women in the United States, but advances over the past 20 years — medications to lower cholesterol and blood pressure, cardiac diagnostic testing, interventional procedures and prevention — have allowed Americans to live longer.
Urinary tract infections, or UTIs, affect both women and men and are the second-most common type of infection. Bacteria entering the urethra is the most common cause. Normally, bacteria in the urinary tract are quickly flushed out, but sometimes they overcome the body’s defenses and cause infection. UTIs are painful, especially if you are traveling with an untreated infection.
West Nile Virus (WNV) is an emerging infectious disease first discovered in Uganda in 1937. Now commonly found in Africa, West Asia, Europe and the Middle East, it was identified for the first time in the Western Hemisphere in the New York City area in 1999. In early spring 2000, it reappeared in birds and mosquitoes and spread to other parts of the eastern United States. By 2004, the virus was found in birds and mosquitoes in every state except Alaska and Hawaii. Experts believe WNV is established as a seasonal epidemic in North America that flares up in summer and continues into fall, and they consider it a threat to public and animal health.
Sound sleep is critical to our health and well-being. We should wake up feeling refreshed and alert, and not feel sleepy during the day. If this is not the case, poor sleep hygiene may be the culprit, but it is important to consider any unrecognized sleep disorder which can lead to poor quality of life, accidents and great expense. If you are not sleeping well, see your health care provider or a sleep specialist.
Ulcerative colitis is a type of inflammatory bowel disease involving the rectum and colon, or large intestine. Affecting 700,000 Americans, it usually appears between the ages of 15 and 40, although children and older adults also develop it. Ulcerative colitis affects men and women equally. Risk factors include a family history of ulcerative colitis or Jewish ancestry.
Celiac disease is a digestive disease that damages the small intestine and interferes with the absorption of nutrients. People with celiac disease cannot tolerate gluten, a protein in wheat, rye and barley. Gluten is also found in everyday products such as medications, vitamins, shampoos and lip balm.
Epidemics of yellow fever struck the United States in the 18th and 19th centuries when it was carried in on ships arriving from the Caribbean. The disease attacked port cities as far north as Boston, including Philadelphia in 1793, but after 1822 it was restricted to the South. New Orleans, Mobile, Savannah and Charleston were hit hard; Memphis suffered terribly in 1878. Yellow fever epidemics caused terror, economic disruption and 100,000–150,000 deaths. Although yellow fever is no longer seen in the United States, travelers may be at risk in some areas of the world.
The Norwalk virus was named in the 1970s when a community in Norwalk, Ohio, experienced an outbreak of this highly contagious infection. Today, this group of stomach viruses is called norovirus or Norwalk-like virus and ranks second, behind the common cold, in occurrence of viral illnesses in the United States.
In the early 1980s, a new, mysterious disease spread through, at the time, the gay community, causing crippling infections and cancers that were killing people. There were concerns about blood supply, transmission through blood transfusions and at-risk populations. In the past 30 years, the United States made great progress in fighting HIV/AIDS. In many developing countries, people are not as fortunate.
Cholera is an acute infection caused by the bacterium Vibrio cholerae that results in diarrhea and severe dehydration. Left untreated, cholera can be fatal in a matter of hours to even healthy individuals. An estimated 3 to 5 million cases and more than 100,000 deaths occur each year around the world.
One of the oldest medical procedures in the world, acupuncture has been practiced in China and other Asian countries for thousands of years. It is a key component of Traditional Chinese Medicine and one of the most common forms of Complementary and Alternative Medicine.
Traditional Chinese Medicine originated in China more than 5,000 years ago. Rooted in the ancient philosophy of Taoism, it evolved over thousands of years to encompass many different practices. Today, TCM is practiced side by side with Western medicine in many of China’s hospitals and clinics.
Whooping cough, or pertussis, is a highly contagious respiratory infection caused by the Bordetella pertussis bacterium, which targets the lungs. Thick mucus forms deep inside the airways, leading to violent coughing episodes that make it difficult to breathe. Droplets transmitted in the air when an infected person coughs, sneezes or talks can spread the infection to others.
Do you remember polio? Poliomyelitis, also known as infantile paralysis, triggers memories of standing in line with my siblings and parents waiting to receive the polio vaccine via sugar cube. We went back three times for vaccine-laced sugar cubes — a smart way to quickly vaccinate many children. Franklin D. Roosevelt contracted polio as an adult and spent much time hiding it from the public.
A recent American Podiatric Medical Association survey revealed travelers spend the majority of their vacation walking. Those who admitted to wearing improper footwear experienced the most foot ailments, including bunions, plantar fasciitis, hammertoe and Morton’s neuroma, all of which can easily be avoided by taking proper precautions.
We asked a small sample of GT readers and colleagues to name the over-the-counter medications they pack when traveling. Here are the 10 most popular, listed with their generic and brand names as well as their generic names in Spanish and French. Some have many brand names; limited space prevented our listing them all.
For thousands of years, men and women have searched for therapies to prolong life and benefit health. The word “spa” is said to derive from the town of Spa, Belgium, celebrated since the Middle Ages for its medicinal spring waters. Pilgrimages to Spa were so popular that by the early 17th century “spa” described any place with a medicinal spring marketed to tourists. Soaking in such waters was also deemed beneficial, so “spa” came to mean any place that featured heated baths, such as Bath, England, established by the Romans as a spa resort in the first century.
For most women, it is safe to travel during pregnancy. If you are not experiencing any complications, there is no reason to delay taking a trip. But travel recommendations may vary, depending on the stage of pregnancy, general state of health and any problems during pregnancy. All pregnant women should have a prenatal examination before traveling and follow their obstetrician’s recommendations.
Headaches are the most common reason for sick days from work or school and the most frequent complaint at doctor visits. Approximately 90 percent of headaches result from one of three syndromes: migraine headaches, tension-type headaches (TTH) and cluster headaches. In 2007, the International Headache Society created a classification system for headaches which enables healthcare providers to diagnose specific types of headache and administer effective treatment.
Our backs are remarkable. They support our bodies through everyday activities including sitting, standing, walking and lifting. We often take them for granted until we injure them. Problems with any of the back’s component parts — bones, muscles, ligaments, tendons, disks and nerves — can cause pain, but most often discomfort stems from muscles and ligaments strained by improper lifting or awkward movement. In some cases, there is a structural problem such as a bulging or ruptured disk, sciatica, arthritis, osteoporosis or skeletal irregularities. The exact cause is unknown in 85 percent of cases, despite advances in medical technology.
According to the American Cancer Society, nearly 200,000 Americans will face a breast cancer diagnosis this year; 41,000 will ultimately die from the disease. Breast cancer is the second leading cause of cancer-related deaths in women, after lung cancer, affecting one in eight women. It also affects men, but the number of cases is small compared to women.
For people with diabetes, travel is easier than ever, thanks to advances in medical technology. But taking a trip can still be stressful due to changes in meal patterns, activity levels and time zones which can affect blood glucose levels. By being prepared, you can keep your blood sugar within your target range and enjoy your journey.
The human foot is remarkable. It contains 26 bones, more than 100 tendons, muscles and ligaments plus 33 joints for flexibility and movement. With such a complex structure, it’s no wonder the foot is more at risk to injury than any other part of the body. Our feet support tremendous pressure from standing, walking and running. In a normal walking gait, two times our body weight is applied to the heel as it strikes the ground — that’s several hundred tons in an average day.
If your vision has become cloudy or things you see are not as bright as they used to be, a cataract may have developed in one or both of your eyes. A cataract is the clouding of the normally clear lens of your eye. Cataracts can affect distance vision and cause intolerance to glare, especially when driving at night. Cataracts can also cause difficulty with reading and seeing a facial expression of a person on television.
Cellulitis is an infection of the skin and the soft tissue underneath, most often caused by bacteria that have entered from a cut, scrape or small crack in the skin. It is a common and, in some cases, potentially serious infection which can lead to hospitalization. Left untreated, the spreading infection can turn life-threatening.
Air travel is so commonplace in our global economy that we rarely think about facing a medical emergency in the air. As we travel more frequently and to greater distances — and as we live longer and travel at more advanced ages — the incidence of in-flight medical emergencies is likely to increase.
Sprains, strains and contusions can happen to anyone — even highly trained and conditioned Olympic athletes. (Case in point: a painful shin contusion that almost prevented skier Lindsey Vonn from winning a gold medal in Vancouver.) These injuries occur wherever muscles, tendons and ligaments are present and can be temporarily disabling until they heal.
Skin cancer is the most common of all types of cancer. In fact, each year there are more new cases of skin cancer than the combined occurrence of cancers of the breast, prostate, lung and colon. More than 1 million Americans are diagnosed with skin cancer every year; one in five will develop skin cancer in the course of a lifetime.
Shingles, also known as herpes zoster, is a viral infection which causes an extremely painful rash. Although shingles can occur anywhere on your body, it most often appears as a cluster of blisters that wraps from the middle of your back around one side of your chest to your breastbone, following the nerve roots of the spine.
A significant portion of our global population experiences some sort of physical, mental or emotional disability that affects their activities of daily living, whether it’s something they were born with or something acquired through accident, illness or war. With the help of positive attitudes and medical and technological advances, however, individuals with disabilities can still enjoy traveling, for business or pleasure.
The enthusiasm for antioxidants began when researchers observed that people who ate diets rich in antioxidants were healthier. In the lab, experiments showed how antioxidants can protect cells from free radicals, molecules with the potential to cause extensive damage to the body’s cells.
Contrary to popular belief, flossing is not just a way to dislodge food caught between your teeth. Regular flossing reduces cavities, gum disease and bad breath by helping to remove plaque, a bacterial film that forms along the gum line. More than 500 kinds of bacteria thrive in your mouth, and they can start to build up in only 24 hours.
Salmonellosis has been in the news due to contamination of some of the U.S. food supply, with the most recent outbreaks connected to peanut butter and products containing peanut butter. The Centers for Disease Control and Prevention and the Food and Drug Administration are collaborating with public health officials in many states to investigate the continuing outbreaks.
For years, physicians believed that stomach ulcers were caused by stress, spicy foods and lifestyle. But in 1982, two Australian physicians identified a link between ulcers and a bacterium, Helicobacter pylori, or H. pylori. This discovery helped the medical community realize that ulcers are a curable infection.
Reports of a passenger infected with tuberculosis flouting international health regulations and flying into the United States put TB in the news earlier this year. More recently, medical researchers at Oxford University in England announced trials of a new TB vaccine — the first in almost 80 years — taking place in South Africa, where the disease is widespread and many strains are resistant to current antibiotic treatment. Suddenly, tuberculosis, a highly contagious life-threatening illness that’s been on the decline in the United States since the 1950s, is a pressing concern. Globally, new infections and deaths from tuberculosis are increasing, most acutely in sub-Saharan Africa and Southeast Asia. Worldwide, tuberculosis kills 2 million people yearly. About one-third of the human population is infected with TB, with a new infection occurring every second.
When it comes to heart disease, the No. 1 killer in the United States, we tend to think of older people at risk. The truth is, heart disease affects men and women, young and old, though the symptoms vary between the sexes. In fact, many times, doctors misdiagnose women because their signs and symptoms present differently from men.
Managing diabetes while you’re traveling can make the difference between enjoying yourself and having a vacation filled with problems. Taking a trip can be stressful on your body, especially given the changes in your daily routine, including different food choices, different time zones and more or less exercise than usual. These changes can have a serious effect on your blood glucose. Keeping your blood glucose within your target range will ensure an enjoyable excursion.
Legendary Hotel del Coronado reached another milestone in its $400 million Master Plan reimagination, with the completion of an extensive, historic restoration of the hotel’s front porch and lobby; a redesigned main entry and drive experience; new guestrooms in The Views area; and refreshed retail concepts.
Since its prestige for attracting the world elite grew in the 1960s, Greece remains the go-to destination for glittering holidays. Each step of the journey is enrobed in luxury, from culinary traditions with the highest standard of execution and name-brand, high-end shopping to first-rate wellness locales and elite accommodations, like 5-star hotels, private villas and yachts.
As a native of the Philadelphia region, I’m quite familiar with the drive in and out of the City of Brotherly Love. Even as the city’s skyline continually transforms, my favorite views of Philadelphia have always been along Boathouse Row, with the Philadelphia Museum of Art rising in the background, before looping around the museum to the flag-lined Benjamin Franklin Parkway. Home to many of Philadelphia’s incredible and world-renowned museums, the Fairmount neighborhood is fittingly aesthetically pleasing and practically synonymous with fine art.
Set to open in 2026, Rosewood San Francisco will be the last skyscraper developed in the downtown region for the foreseeable future. The projected 800-foot-tall property will host a hotel, residences, office and rental spaces. The brand’s third property in California will join Rosewood Sand Hill in Menlo Park, and Rosewood Miramar Beach in Montecito.
The Global Business Travel Association’s (GBTA) Convention 2021 will be unlike any other convention before it, as we come together in person for the first time since the business travel industry drastically changed and look forward to rebuilding and reshaping the future. GBTA Convention 2021 will bring all of us together to learn from experts and each other, in-person at Orange County Convention Center in Orlando, Florida, Nov. 17–19. The safety of our attendees is our top priority. View health and safety protocols.
It’s not even 9a.m. in the sleepy fishing village of Rawai on Thailand’s famous Phuket Island, but already the turquoise waters of the Andaman Sea swarm with local fishermen casting their lines and releasing their nets from the bows of rustic long-tail boats. The scents of lemongrass, incense and sweet pandan leaves season the air as the villagers slowly rise from their beachside bungalows to start their day. In just a few more hours, the fishermen will return with their catches, filling the stalls of the iconic Rawai Seafood Market with buckets of shellfish and displays of fresh filets. Visitors line up each afternoon for the catch of the day, selecting their fish with care before hauling their purchases across the well-worn road to the restaurants opposite the market to have the fish cooked for 100 Thai baht per kilo.
Without a doubt, the pandemic changed the role of airports in the travel industry. Hamad International Airport’s role evolved in many ways since the pandemic hit. Now, more than ever, airports are responsible for creating a secure passenger experience. As the gateway to Qatar and the world, the safety and wellbeing of staff and passengers has always been at the core of Hamad International Airport’s strategy.
Tuscany’s Lucca is home to Grand Universe Lucca, which brings the region’s best wines front and center to its guests. The hotel features three immersive Tuscan Wine tasting experiences: Montalcino, Montecarlo, and Super Tuscan and Chianti Classico.