Sunburn To Saddle Sores: How To Stay Healthy On A TDA Tour
HOW TO PREPARE: An 8 part series to get you ready for your first TDA tour. Click here to read more.
Dr Samuel Covins is a UK-based doctor working in emergency and expedition medicine. He is also a qualified mountain leader and holds the UIAA diploma in mountain medicine. He provides medical cover on international expeditions around the world and is currently working as the Tour Medic on the 2023 Tour d’Afrique. In this article, Sam discusses the role of tour medics, offers advice on how best to prepare for your TDA tour and highlights some of the most common medical issues that arise on tour.
Role of the Tour Medic
Medics play a vital role on a TDA tour. Depending on the type of tour, the medic will either be a doctor, nurse or paramedic with some tours staffed by two medics. Tour medics are responsible for overseeing the general health and safety of both riders and staff. They will also ensure that appropriate hygiene protocols are in place to limit the spread of infectious disease. Before your tour, the medic will review your health information and may contact you to discuss any concerns or make certain recommendations. Whilst on tour, the medic will usually run a daily clinic that you can attend to discuss any medical issues you may be experiencing. Medics will also be ‘on-call’ throughout the tour for any emergencies and can assist you in accessing clinic or hospital care if necessary. Medics will also provide medical documentation to your travel insurance company if required.
Before departing on your TDA tour, you should consult with your own doctor for a review of any pre-existing medical conditions to best optimize your health in preparation for the tour. You should also obtain an adequate supply of your regular medications that will last for the duration of the tour, as it can often be difficult to obtain certain medications abroad. In addition to visiting your own doctor, it is advised that you consult with a travel health specialist to discuss your travel plans and obtain all the necessary vaccinations and travel medications (e.g. malaria prophylaxis, antibiotics, etc). Although each TDA tour medic is equipped with a comprehensive expedition medical kit, you should also ensure that you have your own personal first aid kit that will enable you to self-manage minor injuries and illnesses on tour. Your first aid kit should be personalized to you but should also contain general items that you may require during the tour. You should consider including the following items in your kit: gloves, plasters (band aids), dressings, roller bandages, triangular bandage, gauze, tape, scissors, tweezers, cleansing wipes, paracetamol (acetaminophen), ibuprofen, anti-sickness tablets, anti-diarrhoeal tablets, antihistamine, antibiotic cream, anti-fungal cream, personal and travel medications.
Saddle sores are one of the most common medical issues that arise during a TDA tour. Prolonged periods of time spent seated on a saddle causes excessive pressure on the buttocks and perineum leading to skin damage and breakdown. Sores can range from minor chafing to full thickness skin wounds, which if not managed appropriately can become infected or develop into boils/abscesses.
Here are my ‘Six C’s of Saddle Sore Prevention and Management:
Conditioning: Before your tour, you should ensure that your bike is fitted correctly with a good quality well-adjusted saddle (e.g. Brooks, Ergon, Specialized BG) that you have worn-in well on your training rides. You should also invest in multiple pairs of high quality padded chamois cycling shorts that you have tried and tested.
Creaming: The use of lubricating creams (e.g. Chamois cream/butter) or petroleum-based jellies (e.g. Vaseline) is also recommended to minimize frictional forces on the skin whilst cycling.
Cleaning: Good personal hygiene is essential to limit skin breakdown and prevent saddle sore infections. After each cycling day, you should wash thoroughly with soapy water (or wet wipes if water is not available) and change into comfortable loose fitting clothing. You should also ensure regular washing of your cycling shorts and wear a clean pair each day.
Caring: If you do develop saddle sores whilst on tour it is important to take good care of them. Application of a zinc-based cream (e.g. sudacrem, bepanthen, nappy cream, etc) at night will aid healing the process.
Covering: In addition to healing creams, blister plasters (e.g. Compeed) or specialized dressings (e.g. Moleskin) can be applied to cover the affected areas whilst cycling to reduce friction and prevent infection.
Curing: Ultimately, the most effective strategy for saddle sore management is time spent off the bike to allow the skin to completely heal.
Hydration is key on a TDA tour and failure to maintain adequate hydration can have serious consequences. Long days spent cycling in hot and often humid environments leads to excessive fluid and electrolyte loss through sweating. It is therefore essential to replace these losses by drinking plenty of fluids throughout the day supplemented with rehydration/electrolyte powders. As a rough guide you should aim to consume between 6-8 liters of fluid each cycling day, although individual requirements will vary and some people may consume more than this. In preparation for your tour, you should pack suitable water bottles that will enable you to carry 2-3 liters of fluid on your bike. Only bottled or chemically-treated water should be consumed whilst on tour. Monitoring your urine output is also important and can help to guide hydration. In general, you should aim to pass urine every 3-4 hours and your urine should appear either clear or straw-colored. Darker colored urine should prompt you to increase your fluid consumption.
Intense exercise in hot environments with prolonged sun exposure can lead to heat illness. If dehydration develops and body temperature rises too high, heat exhaustion will occur. Symptoms of heat exhaustion include headache, nausea, dizziness, fatigue, weakness, muscle cramps, thirst and excessive sweating. If left untreated, heat exhaustion can rapidly develop into heat stroke, which requires urgent intervention and can be fatal if not managed appropriately.
To prevent heat illness, you should ensure adequate hydration, wear light-colored heat-reflective clothing and regularly reapply sunscreen (SPF 30 or above) to protect against harmful UVA and UVB rays. Sunglasses are also recommended to protect your eyes from UV radiation. On days with intense sun exposure, you should also consider wearing arm/leg sleeves and a helmet sun vizor for added protection. It is important to note that there are several common medications (e.g. antibiotics, antihistamines, contraceptives, etc) that can cause sun sensitivity and additional precautions may be required.
Gastrointestinal illness is a very common occurrence that will affect most cyclists at some point during a tour. Nausea, vomiting, diarrhoea and crampy abdominal pains are the most common symptoms. Gastroenteritis is typically caused by either viruses or bacteria that are spread by physical contact with contaminated surfaces or through ingestion of contaminated substances. Good hand hygiene is the mainstay of prevention with regular hand washing and use of hand sanitizers. It is also important to give due consideration to your choice of local cuisine. Generally, foods that have been freshly prepared, cooked thoroughly and served hot are safe. Reheated, undercooked or buffet-style cuisines should be avoided. Seafood should also be avoided. Fruit and vegetables should be washed and freshly prepared.
In any case of gastroenteritis, rest and rehydration are essential in order to replace fluid and electrolytes lost through diarrhoea and vomiting. Oral rehydration sachets are advised. Anti-sickness (e.g. ondansetron, prochlorperazine, etc) and anti-diarrhoeal (e.g. loperamide) medications can also be taken for symptom management. In cases of persistent gastroenteritis, a course of antibiotics may be required and you should consult with the Tour Medic.
Malaria is an infectious disease caused by a parasite called Plasmodium that is transmitted by mosquitos. Symptoms of malaria include fever, shivering, headaches, nausea, vomiting and aching muscles. If left untreated, severe cases of malaria can be fatal. There are several TDA tours that travel through high-risk malaria zones and it is strongly advised that you take anti-malarial medication on these routes. You should consult with your travel health specialist about the different anti-malarial medications available. It is important to note however that anti-malarial medication does not provide 100% protection against contracting the disease. You should also take reasonable steps to avoid being bitten by mosquitos by using insect repellant (e.g. DEET) and wearing long-sleeved clothing. The use of mosquito nets is also recommended. If you suspect you may have contracted malaria whilst on tour, you should inform the tour medic immediately.
How to Prepare
An 8 part series to get you ready for your first TDA tour. Click here to read more.