Over the next few minutes you inexplicably start to feel unease.  You experience some of the following sensations:

• Feeling faint or dizzy
• Your limbs tingle or go numb
• Tightness, discomfort or pain in your chest
• Your throat closes up and you can’t swallow
• You become fearful of dying
• Your heart speeds up, pounds or palpitate
• You start shaking
• Shortness of breath, or you feel there is not enough oxygen in the air
• You start sweating profusely
• You have a cold chill or a hot flush
• Your tummy feels disquieted
• You feel nauseous
• You become detached from yourself
• Things start feeling unreal

Copyright DIY Travel Expert

You could be suffering from a panic attack.  (You could also be having a heart attack.  If you are at all unsure, ask the cabin crew for help right away.  As with other medical conditions, panic attacks need to be properly diagnosed by a medical professional.)

Panic attacks are extremely unpleasant, scary and disturbing; and typically last from a few seconds to around half an hour.  They are triggered in part by the anxiety that one experiences in the build-up to the flight, which makes it a much bigger deal than it really ought to be.

The first bit of hope that we can give you is that, although you feel that you are going to die, one does not die from anxiety or panic attacks.  It will go away, and you will get over it, however you may feel when in the grips of one.  The physical symptoms you experience at the time make the psychological strains that much harder to bear.  Some admit to having prayed for death.

What can you do about panic attacks

For a number of people anxiety precedes the panic.  If you are able to reduce the anxiety, you may well be able to ward off the attack.

It is said that the writer Tolstoy and his brother claimed to be members of an exclusive club.  Membership was obtained by standing in a corner for half an hour and not thinking about anything white.  If you try it you will soon find that you are thinking of the word white and white things.  The brain cannot unthink any idea – it is made to think about something.

You can’t “fight” anxiety any more than you can concentrate on not-thinking about something white.  You have to replace you’re anxious thoughts with peaceful, calm and pleasant thoughts.  Or put another way, you must divert your attention elsewhere.

1. Medication.  Responsible physicians can prescribe non-habit-forming drugs that can provide support to alleviate the anxiety and panic, without impacting on your intellectual capacity or reducing you to a zombie-like state.  Anxiety can also be a side-effect of medication that you might be taking for other conditions, in which case your medical practitioner may try changing the prescription to alleviate the symptoms.  Diet pills and cold and flu medication can heighten anxiety.  You may also be advised to avoid certain foodstuffs, for instance caffeine, that can heighten anxiety in many people.  Certain anti-depressants may take a month before they are fully effective, and you would need to take them even when you are not experiencing an attack.

Benzodiazepines are not recommended by many medical practitioners.  They take 30 minutes to an hour to act, by which time the panic attack would have subsided by itself, and they are highly addictive.

2. “First-aid”.   Relax.  Options that you may have when on the ground, like going for a walk outside, are clearly not available to you when you are in the air, which can greatly heighten the tension of the experience.  If you feel the beginnings of a panic attack, close your eyes.  Breathe in and out deeply a few times.  Try to relax any areas of your body in which there is muscular tension.  If you are travelling with a loved one, get them to massage the back of your neck.  Physical contact is a deep-seated need in humans and appropriate physical contact can provide silent reassurance.  Hugging or grabbing the hands of strangers will create additional problems of a different kind.

3. Think positive thoughts.  Having a Polly-Anna outlook on life is not what we mean.  When you are experiencing a panic attack, imagine being in a happy, peaceful place.  What is important is that you must push your thoughts in a positive direction.  By thinking about something nice, you drive out the anxious thoughts, at least for a while.

4. Eliminate sources of anxiety.  This is something that you can only do before or after the attack, not during one.  In fact if you try address these causes during an attack you are likely to just make it worse.  If you are going through a crisis in your life then you probably need to get help with that rather than looking at the travel aspects – it is best to attend to root causes.  And you may need professional help with that.

If the source of anxiety is the travel itself then you are already doing something useful about it by reading DIY Travel Expert.  Understanding the symptoms is a good starting point.  We also have articles that explain what is happening during various stages of the flight and considerations as to how you can ensure your personal safety.  Knowledge about flight operations is one established way of fighting fear of flying.

Psychologists specialising in travel anxiety are likely to use two approaches: cognitive behavioural therapy or exposure therapy.  Cognitive behavioural therapy unpacks the thinking and behaviours that lead to the attack and help you to understand your fears in a realistic way.  Reading our series of articles on fear of flying and anxiety will provide much information that can assist with this.

Exposure therapy typically means taking a course in which you are shown around the aircraft, get to sit in it when it is not going to go anywhere and gradually desensitise yourself to your fears.  The good news is that this is not needed for most people.

This food advice is useful even if you are not travelling – even in the USA 250,000 people are hospitalised each year for diarrhoea, and the food safety in the United States is a great deal better than it is in many countries.  There are other examples too: thousands of people got sick and dozens died in mid-2011 from eating raw vegetables originating in Germany, which were contaminated by a strain of E. Coli bacteria.

The cause

Traveller’s diarrhoea (unkindly called various local names including Delhi Belly and Montezuma’s Revenge) and related problems are caused by contaminated food.

Avoiding illness while travelling – What you touch

Good personal hygiene, particularly about one’s hands is critically important in preventing infection whilst travelling.  Wash your hands before and after using the toilet, after handling money, and before meals.  Also wash your hands before touching your face or putting your fingers in your mouth.

Only use potable water to rinse your mouth and toothbrush when you brush your teeth.  Also, do not use water you would not drink to clean items in close contact with eyes and mouth, such as contact lenses.

Be careful about swimming in fresh water.  Aside from the risk of pollutants, you may also unwittingly be exposing yourself to parasites including river blindness and bilharzia, caused by parasitic worms.

First aid

Stay hydrated.  The volume of liquid you take in must approximate the amount of liquid you lose.

The water that you drink must be clean and uncontaminated.  If it is at all suspect you can boil it for twenty minutes to kill off the bacteria.

Research has established that pure water is not absorbed by the body as fast as a mild solution of electrolytes.  You can buy “Oral Rehydration” sachets to add to water, or you can make up your own in an emergency.  The basic recipe is:

1/2 to 1 level teaspoon of salt

6 to 8 level teaspoons of sugar

1 litre of clean, drinkable water

Antimotility drugs are useful as they slow down the rate at which food passes through your body.  This will at least give you the time to get back to your hotel, call a doctor, etc.  Your doctor or pharmacist can advise you which ones to take with you.

See a doctor

Several food poisoning causes are potentially life-threatening and you should always 1) stay hydrated with clean water and 2) exercise caution and see a competent doctor, particularly if the symptoms are severe or protracted.  Diarrhoea can even be a symptom of a serious tropical disease that needs additional specialist medical treatment.

Avoiding illness while travelling – What you eat

The most frequent cause of  illness while travelling is food contamination, caused by:

• Improper food storage and handling leading to bacterial contamination
• Infection by micro-organisms: bacteria and amoebas, protozoa
• Chemical residues and contamination
• Toxins produced by fungi

You should avoid:

• Hot food that has been allowed to cool down
• Cold food that has warmed up
• Reheated food
• Food that has been uncovered or exposed to flies or other creatures

Chicken is particularly treacherous if undercooked.  Even if grilled, it can have uncooked portions if it was put on the griller directly from the freezer.  Boiled or baked is probably the safest.  Microwaved chicken is probably the least safe because you do not know if it has been heated sufficiently right through.  If there are raw or undercooked parts of the chicken, don’t eat it.

Beef should be well done unless you have sound reason to trust the kitchen (for instance if it is a Michelin-Star kitchen then the chances are that even Steak Tartare is safe to eat).

Avoid food prepared in the street, particularly if there is a possibility for cross-contamination between raw meat and cooked meat.

Buffets can be suspect.  The food is exposed for extended periods to contamination, including people coughing and sneezing near them.  You do not know how good the hygiene is of people that have used the serving utensils, so you could be getting germs on your hands while serving.  It is also possible for tongs or spoons to fall into the dish, thus contaminating the food.

Buffets are also bad because it is rare that the temperature control is adequate.  Hot foods need to be kept hot in order to destroy bacteria.  Once they cool down to merely warm they actually promote bacterial growth.  Hot food kept hot (over 40° C) will be over-cooked in a relatively short period of time.

Cold foods also need to be kept cold.  The rate of bacterial growth doubles with every 10° C increase in temperature.  (Around 20° F temperature change.)  A salad may be at freezing point at the bottom but near room temperature at the top surface.

It there is any slight symptom at all of fungus infection of food, do not eat it.  Visible fungus is often very small in relation to the mycelium penetrating the food, so by the time it shows the whole mass of food may be infected.  Fungi produce poisons called mycotoxins that are not destroyed by cooking.  One group of such poisons called aflatoxins are among the most carcinogenic substances known, but you first have to survive the initial poisoning for that to be a worry.  Many do not survive aflatoxin poisoning.

Fresh fruit and vegetables

Fresh fruit and vegetables are potentially dangerous because you have no idea if they are contaminated or if they have been properly cleaned.  In the tropics it is necessary to do more than merely washing fruit and veg. : they need to be soaked and scrubbed in a dilute chlorine bleach to kill off the amoebas and avoid things like amoebic dysentery.

Avoid salads for this reason.  Not only are salads rarely washed thoroughly enough, in addition to bacteria and amoebas they can also harbour parasitic organisms like flukes and snails, particularly in tropical regions.

Eat only vegetables that have been boiled for an extended period, or baked.

Avoiding illness while travelling – What you drink

Bottle of water

Avoid anything containing ice as it is only as good as the water it was made from, as clean as the kitchen it came from, and as pure as the containers and plumbing it has been handled with.

Some countries have entirely safe tap water supplies, which you can determine when researching your destination.  Others, even first-world countries, may have dubious water quality and you should drink only bottled water.  Some countries (for instance Turkey) have water certification procedures and your hotel will display a certificate that indicates their care in relation to water supply.  That does not mean that you can drink their tap water, but merely means that they may, for instance, have safe drinking water available to guests.

It can be difficult or impossible for you to purify contaminated water by yourself as a traveller.  Treatment with iodine or chlorine tablets will help to kill off bacteria if done correctly.  However, this is not magic, and cannot remove metal contamination, or chemical and pesticide residues, etc.  There are other possibilities that first filter the water, then sterilise it usually with activated charcoal, or ultraviolet light.

If the local water is unsafe then use only reputable bottled water (or water stated as potable that is provided by a certified hotel).  If you cannot get bottled water then drink brand-name bottled soda drinks: Coke, Pepsi, etc.  Staying hydrated is more important in the short term than a few extra calories or the state of your teeth