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Controlling High Blood Pressure  

Johns Hopkins Health Alert asks: “How does drinking alcohol affect blood pressure? And is it better to take blood pressure medication at night or in the morning? Dr. Lawrence Appel, professor of medicine at Johns Hopkins, provides the answers.

How does drinking wine or other alcoholic beverages affect blood pressure?

Dr. Appel: There is compelling evidence that high alcohol intake is associated with high blood pressure. The question is, among individuals consuming one to two drinks a day, what is the benefit of alcohol reduction?

Quite frankly, the evidence is very sparse, so I don't typically recommend alcohol cessation for blood pressure control among persons who drink one or two drinks per day. But if a man or woman has more than two drinks a day, I recommend reducing alcohol intake. People also need to be aware of the large amount of calories in alcohol, and how those calories could contribute to weight gain or difficulty losing weight.

Is it better to take blood pressure medication at night rather than in the morning?

Dr. Appel: Some clinical trials have been attempted to examine whether this is true, but these have been disappointing in terms of results. We've done a clinical trial in chronic kidney disease patients with elevated nocturnal blood pressure, and there was no benefit.

My advice in terms of the timing of blood pressure medication is adherence, adherence, adherence. Medications should be timed to make it easy for patients to take them. I recommend linking pill taking with some activity.

In the morning, if you link taking your blood pressure medication with brushing your teeth, that's great. Or at night, if you want to take your blood pressure before you go to bed, that's fine -- unless it's a diuretic, which shouldn't be taken at night unless it's long acting. Given limited data on the medical benefits of timing, adherence should be the major driver for timing of your medications.

Posted in Hypertension and Stroke on May 20, 2014.


The Origins of Memorial Day

At least two dozen communities, throughout the North and South, claim to be the first ones where women cleaned up and decorated the graves of soldiers killed during the Civil War. One report says that freed slaves reburied Union soldiers from a mass grave near Charleston, S.C. in May 1865, followed by a parade and celebration.

The 30th of May was proclaimed as Decoration Day when Gen. John Logan, national commander of the Grand Army of the Republic, issued an order in 1868. Congress changed Memorial Day to the last Monday of May in 1971.

We witnessed flags and flowers placed at about 250,000 graves in Arlington National Cemetery by military members and volunteers on Saturday, May 24, 2014 in Virginia. In addition, “Thousands, if not hundreds of thousands, of flags” will be placed on the individual graves of veterans throughout the country, said Mike Buss, deputy director of The American Legion’s national headquarters in Indianapolis, Ind. It’s done by local chapters of The American Legion and the Veterans of Foreign Wars, working with Boy Scouts, Cub Scouts and other organizations.

“In the morning, flags will fly at half-mast to thank those who gave the sacrificed their lives in defense of of our freedom, until noon when the flags are raised to full-staff to thank those who are still living, who are either on active duty or who have served,” Buss said. It’s the only time a flag is at half-mast for just part of the day.

Around 5,000 people are expected to attend a ceremony at Arlington National Cemetery where the President lays a wreath on the Tomb of the Unknown Soldier. And the roar of "Rolling Thunder" motorcycles will soar, in Washington DC, as they honor the veterans and those who died in the war. 

Overseas, French schoolchildren will be dismissed from school to lay roses on the more than 14,000 graves of American servicemen in Meuse-Argonne Cemetery.



Things Backpackers Do But Don’t Admit to Doing

Backpackers and budget travelers aren’t always the world’s most ethical travelers. Having little money, and being in places where no one knows them, they can get away with quite a bit. For the most part, it’s nothing terrible, just a few misdemeanors.

The following article has been adapted and shortened  from Kalia Krayewski's recent article in Here are a few things the author notes that many travelers do but don’t like to admit:

Wear Dirty Underwear. Sometimes, travelers forget to do laundry. Sometimes they just don’t take the necessary time to do it. Sometimes, they don’t want to pay for it, or whatever. It’s just not always possible to maintain a fresh supply of clean underwear on the road, and you just have to pull a pair out of the dirty pile, shrug your shoulders, and suck it up and put them on. Just pray that you aren’t in a humid, tropical environment when this happens. The only thing worse than putting on dirty underwear, is telling other people that you’ve put on dirty underwear.

Steal Toilet Paper. When washrooms rarely have toilet paper, and you’re on a low budget, the temptation of taking extra napkins from the café you’re in, or even taking a whole roll from a restaurant’s washroom or any public bathroom, can overtake many a backpacker, clandestinely walking around with a huge wad of toilet paper in his or her backpack.

Pee in the Water. Be it a lake, an ocean, a pool, whatever, backpackers love it when they can avoid the often dirty, dingy toilets that are found in backpacker-frequented areas. And when you’re on a beach, the temptation to use the sparkly ocean as a toilet can outweigh any moral dilemmas they might have about it.

Lie about their status. Whether it’s saying they’re a student to get the student discount, pretending their significant other is their cousin in order to get a room with them (in religious countries), pretending to be royalty from an obscure country in order to garner attention and preferential treatment, or saying they’re married to get an aggressive local off their case, backpackers don’t usually hesitate before making up some convenient alter-ego.

Stereotype. We hear it all the time: Typical Germans – always have to leave right on time; those Japanese and their cameras; they must be American since they’re loud, etc. Backpackers get to know different nationalities and quickly form opinions of the entire nations from these encounters. In addition, they do not hesitate before sharing their misinformed opinions with their fellow travelers.

Drink their Dinner. When on a tight budget in a party town, sometimes backpackers have to choose between food and drink – and many backpackers choose the latter, thinking they’ll also save on booze since drinking on an empty stomach is far more potent than on a satiated stomach. But they don’t usually tell their friends, since this is also known to be a sign of alcoholism.

Put Toilet Paper Down the Toilet. In many backpacker countries, the plumbing is not developed enough to handle toilet paper down the toilet. There are signs everywhere imploring travelers not to throw anything down the bowl. But muscle memory often takes over and the toilet paper ends up in the wrong spot more often than most backpackers would care to admit.

Crave Western Food. Backpackers are meant to be well versed in travel culture, eating local foods and turning their noses up at western chains like McDonalds. However, though few admit their Big Mac cravings, every traveler sneaks into a western chain every once in a while. And if they aren’t in an area where western food is available, they will just dream about it.




8 Backpacker Travel Safety Tips

These days, due to the poor economy and job losses, people of all ages are hitting the road with a backpack to save money while they travel. The tips that follow assumes that you’ve taken the time to research your destination.

You are aware of what local customs you may need to adhere to (a headscarf for women in Muslim countries, for example), what vaccinations you need, whether you need a visa or not, and what kind of medical facilities are available. You can research your destination in a number of ways but I recommend starting with the U.S. State Department website for good advice.

You have taken the time to choose the right backpack. There are loads of websites that will help you, but the best way to be certain is to take a practice trip with your backpack. Only then will you know what you really need to pack and what can be left behind. Remember, you can do laundry at almost any hostel and you can buy laundry detergent almost anywhere you go.

Take a Defense Class Before You Go. You can find self-defense classes everywhere. You’ll learn some safety strategies and how to defend yourself against attackers should you need it. You won’t be able to take on a well-trained and experienced criminal, but you’ll have more confidence if you find yourself facing a common mugger.

Sew Hidden Pockets into Your Pants. In lieu of a money belt, sew hidden pockets into your pants and carry those valuable items (cash, credit cards, passport, etc.) in those pockets. If a mugger searches under your clothes for a money belt, they won’t find one. Pockets can be easily hidden in the pant legs with a little seamstress skill.

Update your Travel Medical Kit. Depending on where you are going, you’ll want to update your travel medical kit. Do research on the health conditions for your destination and update your travel medical kit accordingly. Pack small amounts of things like sunscreen and hand sanitizer that you can pick up at stores when you arrive instead of carrying as much as you’ll need for the entire trip.

Pack a Doorstop and a Cable Lock. A doorstop is an inexpensive safety device. Stick it under the door when you’re locked safely into your room at night and you have one of the simplest way to prevent someone from breaking in. A cable lock helps you lock your valuables to an immovable object – like the toilet plumbing – if you want to drop some of your load and explore sans the backpack.

Divide your Cash. The majority of your cash should be divided into multiple hiding places. Some in your hidden pockets (so you can step into a restroom and access it if necessary) and some hidden in your backpack (tuck it in a plastic bag in the bottom of your pack or in the hidden pocket of your spare set of pants). By dividing up your cash, you ensure you don’t lose it all if you are robbed. Keep only the amount you need today in an old, beat-up wallet shoved way down into the front pocket of your pants.

Resurrect an old Cell Phone. A backpacking trip is not the best time to take your expensive electronics. You’ll find Internet cafes everywhere so you can catch up on email. If you dig out an old cell phone, you can sick a local SIM card in it to keep in touch and not worry about losing it. Don’t forget to store the emergency number – the equivalent of 911 for the country you are visiting – in your phone before you go.

Pack your Resume. If you get robbed or run out of money and need to get a job to earn money, you’ll be glad you had this document handy. You can email it to yourself, store it in a cloud, or have it on a flash drive, but it’s a good idea just in case.

Buy Travel Medical Insurance. It’s inexpensive and if you are injured or get sick, you’ll be happy knowing that the insurance company will cover your medical care no matter where you are traveling. Plus, it has a number of other benefits, including helping you get home quickly if you include emergency medical evacuation coverage.

EF thanks the Travel Association for these tips.


Cruise Health

Related Categories: Cruise HealthInfectious Diseases

Each year the number of cruise passengers increases and the news of illnesses on board also seem to increase. The following article has been adapted and shortened from “Cruise Health” by the International Association for Medical Assistance to Travelers (

Illnesses on large ships have a ripple effect; living in close quarters with hundreds or thousands of other travelers for an extended period of time not only exposes you to infectious diseases., but can also have a negative health impact on host port communities where passengers disembark for sightseeing tours and on-land activities.

What are common illnesses found on cruise ships?

Gastro-intestinal illnesses (gastroenteritis) caused by noroviruse. coli, and salmonella can be present on cruise ships. These highly contagious viral and bacterial infections are transmitted by:

Ingesting contaminated food and fluids 

- Improper hand and body hygiene

Touching infected surfaces and objects

Coming into close contact with a sick person

Symptoms usually develop within 12 to 48 hours after exposure and can appear suddenly. They include vomiting, watery diarrhea, abdominal cramps, fever, headache, and nausea. The illness typically lasts 1 to 2 days, but you can be contagious anywhere from 3 days to 2 weeks after getting sick. 

Respiratory illnesses such as influenza are also common on ships. The virus is transmitted among passengers through infected air droplets by sneezing or coughing. A person can be contagious 1 day before and up to 7 days after symptoms appear. Symptoms include high fever, sore throat, nasal congestion, high fever, muscle aches, headache, fatigue, and general weakness. Patients usually recover after 1 or 2 weeks, but the illness can cause complications in young children or persons with pre-existing health problems.

The hepatitis A virus is transmitted through contaminated water and food or by the fecal-oral route, and may cause severe liver damage. Hepatitis A symptoms can mimic the flu - fatigue, nausea, abdominal pain, fever, loss of appetite, and jaundice (skin and eyes). Symptoms appear anywhere from 2 to 6 weeks after being exposed. The illness can last up to 6 months. However, some people are long-term hepatitis A carriers and will not exhibit any symptoms during their lifetime.

Legionnaire's Disease is a lung infection caused by the Legionella bacteria. Passengers acquire the infection when breathing contaminated air droplets from water found in hot tubs, hot water tanks, building air conditioner and plumbing systems that are not properly cleaned and disinfected. Symptoms mimic pneumonia (cough, chills, high fever, muscle aches and headache) and usually appear 2 to 14 days after being exposed. If caught and treated early with antibiotics, patients can make a full recovery. The bacteria does not spread from person to person. 

Due to the different immunity status of passengers and being in a confined area, persons who are not vaccinated are also at higher risk of contracting vaccine preventable diseases.

What should I do before my trip? 

Consult with your doctor to make sure your routine immunizations are up-to-date. We also recommend getting the hepatitis A and B vaccine.

If you have any chronic illnesses such as diabetes, heart disease, or a compromised immune system, ask your health practitioner if taking a cruise holiday is right for you. You may want to consider specialty cruises for passengers with chronic illnesses and disabilities.

If you are sick before your trip, advise the cruise company to see if there are alternatives or if you can postpone the trip. You don't want to be responsible for making other passengers sick.

Research your cruise line's reputation. Tour companies are required to report any illnesses and evaluations are publicly available through government websites. If the ship reported illnesses in the past, find out how they dealt with it and what measures they have taken since to prevent the spread of infectious diseases.

Check if your cruise trip is covered by your travel health insurance.

How do I protect myself and others?

Wash your hands often and thoroughly. We cannot emphasize this enough! Good hand hygiene is proven to reduce illness and the spread of infectious diseases. Wash your hands with soap and water for at least two minutes before eating, after using the toilet,.

Stay healthy and hydrated. Drink lots of water, eat healthy foods, and get regular sleep. Check out your cruise ship's exercise room and wellness schedule. Book an aerobics, pilates or yoga class. Maintaining a healthy immune system and good mental health will decrease the risk of getting ill during travel.

Boil it, cook it, peel it, or forget it should be your mantra when travelling. Many cruise lines have a good reputation when it comes to food preparation and handling. However, when you get off the ship make sure to eat well cooked foods or fruits that you can peel. Avoid shellfish, meat, and dairy products that have been out for a long time.

Practice safe sex. 

What to do if I or others around me get sick?

If you get sick, immediately report your illness to the cruise's medical staff. They will tell you what precautions you should take to improve your health and prevent further infection. 

If someone gets sick in your vicinity (such as vomiting or diarrhea), leave the area and notify medical staff. 

Avoid shaking hands or being in close contact with other passengers. Make sure to wash your hands frequently.

For more information on ship health go to:

Health Canada Cruise Ship Inspection Program 

CDC Vessel Sanitation Program 


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