preventative prior to exertion. Before you travel, be sure that your asthma is under good control (episodes occurring no more than once or twice a week) and that you have an ample supply of both maintenance and emergency, quick-relief medications. Drugs recommended for some travel ailments — including aspirin and other nonsteroidal anti-inflammatories such as ibuprofen (Advil) — can initiate an asthma attack, so avoid these drugs if possible.
C HOLE LI T H I ASI S Cholelithiasis is a chronic condition characterized by a presence of gallstones in the biliary ducts and gallbladder. Gallstones may cause obstruction of the biliary system and prevent excretion of bile into duodenum. Pressure will increase and cause pain, which can be episodic and transitory. The condition may worsen and result in prolonged, acute painful episodes. Cirrhosis, diabetes, hemolysis and Crohn’s disease have been associated with gallstones. The gallbladder may generate pain and cramping to the right upper quadrant just below the right rib cage and can radiate to the right shoulder and scapula. It is classically seen in obese females and people older than 40, but it also occurs in a much wider range of the general population. Gallstones occur in more than 5 percent of asymptomatic people. The characteristic right upper-quadrant pain radiating to the back is often associated with a fatty meal, but this pain can occur at other times, often at night, and is usually unaffected by position, bowel movement or flatus. Nausea and vomiting may also occur. Imaging often confirms the diagnosis. Should the gallbladder become infected, accompanied by increased pain, fever and chills, seek prompt medical attention as these worsening 108
symptoms can be cholecystitis. Palpation just under the right rib cage with a
