Taking a multifaceted approach to the health risks of international competition is the best way to ensure you are healthy and in top form throughout your adventure. This approach entails looking at the ways in which you will be challenged from the physical, nutritional, and mental perspectives, and taking the required steps to reduce your risks in each area.

To illustrate the many issues you will face at an extreme international event and some of the solutions you can adapt to keep you healthy and safe, let's follow two composite characters as they prepare for and participate in extreme events.

Meet Michael and Sally

An avid distance runner for sixteen years, Michael is about to put himself to the biggest challenge of his life, the Antarctic Ice Marathon. He will travel to a location a few hundred miles from the South Pole, where, at an altitude of three thousand feet, he will attempt to complete a 26.2-mile course. He will face average windchills of minus-twenty celsius, forceful winds, and snowy, icy terrain.

Sally is also putting her body and abilities to the test, but she's opted to do so in a completely different environment. The Marathon Des Sables is billed as the toughest footrace in the world, and for good reason. Sally, who has already completed many tough marathons, will spend six days in the Sahara desert, attempting to complete a 243-kilometre course. She will have to carry her supplies, face a temperature of 120 Fahrenheit, and cross vast expanses of uneven terrain and sand dunes.

Setting the Stage for Good Health

Effectively managing the health risks of international events requires early preparation. As soon as you have made a commitment to compete you should undergo a full health assessment. This will give you baseline information you will need throughout your adventure and allow you time to deal with any current health issues.

The medical portion of the health assessment is the same for both our contenders, although each will undergo required gender-specific tests. The assessment includes taking a complete medical history and performing a complete physical examination of all body systems. In addition, laboratory analysis should be performed for blood count, fasting glucose, cholesterol and triglycerides, kidney function, liver disease, coronary heart disease and thyroid function. Due to the extreme nature of the events, Sally and Michael also want to check their lung capacity, neurological function and cardiovascular risk.

When the assessment is complete, Sally and Michael are each given a copy of their medical histories to take with them on their trips.

Gathering Information

To protect your health while in another country, you need to know exactly what health risks you face. Michael and Sally must find out as much as they can about the countries they are going to and the events they are participating in and share that information with their health-care providers, who can then analyse the risks and provide solutuions.

The first step is to discover what vaccinations are needed. Michael is lucky; there are no required vaccinations to visit Antarctica. But his personal history reveals that Michael has never had, or been vaccinated for, chicken pox. While the risk of contracting the chicken pox virus prior to or during his marathon is low, Michael does not want to take chances and must receive two doses of the vaccine four to eight weeks apart.

Sally is not as lucky. Her trip to Africa puts her in danger of contracting Hepatitis A, meningitis, tetanus, diphtheria, and yellow fever. She must ensure she receives her Hepatitis A and meningitis vaccines at least one week before leaving and her diphtheria and tetanus vaccines at least one day before departure. The vaccine for yellow fever must be given at least ten days before departure.

Sally's nurse practitioner also talks to her about the prevalence of HIV, the virus that causes AIDS, in Africa, and provides Sally with information about protecting herself through abstinence and using a condom.

Although vaccines will protect you from many serious illnesses, they will not, of course, keep you from falling ill while abroad. Common "bugs" in the country you are visiting may have no or little effect on residents but make you very ill simply because you have not developed immunity to them.

This is of much more concern for Sally than for Michael, but both receive education on protecting themselves from contagious illnesses. On the surface, this advice seems to be common sense and not worth discussing. Circumstances may, however, make it difficult to practice preventative measures. Sally, who will be sleeping in a tent before and during the race and preparing food in the middle of the desert, will have to plan how she will get enough rest, ensure her hands are kept clean, and deal with fresh produce, which should always be washed with clean water or peeled. Her health-care providers help her determine the steps she can take to overcome these challenges.

Don't take your ability to practice good hygiene and other preventative measures for granted when in another country. Like Sally, share as many details as you can about your journey with your physician, nurse practitioner, or dietician. They can identify potential challenges and help you avoid them before you board the plane.

To be continued...

Sally and Michael are well on their way to staying healthy throughout their events. Next tme, we'll follow them through the remainder of their pre-departure preparations to see how they manage stress and plan for their physical and nutritional needs while far from home.

About the Author

Dr. Rohan Bissoondath is the medical director of Preventous Collaborative Health in Calgary, Alberta.