Healthy Travel

6/24/2009 12:14:22 PM

Chronic medical conditions don’t have to keep anyone homebound.

Chronic medical conditions don’t have to keep you homebound.

Modern health care can now effectively manage chronic illnesses such as diabetes, heart disease, asthma, HIV and COPD (chronic obstructive pulmonary disease). People with such conditions often live long and full lives — lives that include travel.

But anyone organizing a group vacation should plan ahead to accommodate a person with a chronic illness and be equipped for emergencies. Even a condition as common as a food allergy requires travel planners to be alert and proactive.

“The onus is primarily on the traveler to be aware of his or her disease, to know which medications he or she should be taking or have available, and of the potential symptoms and complications of their disease,” says Andy Nish, M.D., an allergist who is a member of the Public Education Committee of the American Academy of Allergy Asthma and Immunology.

Unlike physical disabilities covered under the Americans With Disabilities Act (Click here for advice on traveling with mobility challenges.), there is no legal requirement to accommodate chronic medical conditions, says Dr. Phyllis Kozarsky, a consultant on travel health at the Centers For Disease Control and Prevention in Atlanta. “Planners should ask if all the activities and the itinerary are appropriate for the traveler. Some people have an unrealistic view of what they can do. They may need a reality check,” Kozarsky adds. “Communicate what the trip is and let the traveler decide.”

Considerations include how much walking will be involved, what the temperature will be and what kind of sleeping accommodations will be provided. Other factors include high altitudes that can cause shortness of breath, and long plane rides that can, for example, increase the risk of blood clots for those with heart disease.

“Travel with a chronic illness may be limited in a group situation because the person may not be able to keep up with the group,” warns M. Assunta Marcolongo, president of the International Association For Medical Assistance To Travelers. “People traveling with oxygen cannot go to Africa on a safari, for example. It’s just not feasible. There are limits. It depends on how bad the medical condition is and what the doctor says. Is it a safari or just sightseeing in Florida?”

Getting ready
Here’s a to-do list when preparing for a trip involving a person with a chronic medical condition:

- Get the doctor’s OK. Ask for a letter from the traveler’s doctor confirming that they had a checkup and are ready to travel. The letter should specify the purpose of the trip and who the patient is. “It needs to be a recent checkup to confirm that the traveler is able to go on this particular trip,” Marcolongo says.

- Be prepared. Take along a full list of medications from the doctor including dosages and generic names, and a full supply of medications, separated into two batches in case one gets lost in checked baggage.

“People should see their primary care physician to make sure they have ample medication to make it through the trip,” Kozarsky says. “Everyone should carry a travel health kit including their usual medication and whatever they need in case of an exacerbation of the condition. They should walk up and down the aisles of their favorite pharmacy and pick out what they would want to have with them at home if they had a problem.” For example, diabetics should carry plenty of insulin, syringes and other supplies, and should instruct a fellow traveler what to do in an emergency. Sugar cubes or other forms of easily carried sugar are essential for diabetics to have on hand. A medical ID bracelet or necklace informs others that someone has a condition. All travelers should carry emergency contact numbers.

- Be aware. Research access to medical care and transportation at the travel destination, especially if it is remote. “Is there a hospital for a cardiac patient? Is it 50 miles away or 100 miles away?” Marcolongo asks. If possible, there should be a travel companion who knows about the person’s illness and medical history.

A group leader should be aware of some of the most common and most serious potential issues for a particular condition. Web sites like WebMD can help. Group travel leaders also would be well served to take a Red Cross or similar course in CPR and basic first aid, says Nish. They should be aware of potential complications, such as increasing shortness of breath in travelers with COPD or congestive heart failure.

- Get insurance. Kozarsky encourages anyone with a chronic illness to get several types of insurance. First of all, they should get trip cancellation insurance, which is inexpensive. They should also consider travel health insurance because some medical insurance providers (including Medicare) do not provide coverage out of the country. Finally, they should consider evacuation insurance that would pay to transport them closer to home if they needed health care. People with chronic illnesses may be more likely to fall, get pneumonia or otherwise need medical care, says Kozarsky. Read the fine print closely, suggests Marcolongo: “Each insurance policy is different.”

During the trip
Whether a trip is domestic or overseas is clearly not the most important variable, says Kozarsky. “A luxury hotel in London might be safer than a high altitude in Colorado,” she says. However, travelers should especially beware of counterfeit medicines overseas, another reason to carry along a full supply.

It is also helpful to offer alternative activities if a planned activity is particularly strenuous. Often a chronically ill person might need to take an afternoon off from scheduled activities to rest. “It’s important to keep an extra eye on travelers with chronic diseases, particularly if they are traveling alone,” Nish says.

COPD patients should make sure they have an adequate supply of oxygen at all times, according to COPD International. Travelers on airplanes are not allowed to fly with their own oxygen but may be able to arrange to use oxygen on the plane (usually an unreimbursed, out-of-pocket expense).

People with food allergies are generally accustomed to avoiding foods they are allergic to, but it can be harder to do in an unfamiliar environment, particularly in a foreign country where they may not speak the language, says Nish. The travel leader should coordinate with restaurants to be sure they are aware of a traveler’s food allergy, and they can be an advocate for the person with the food allergy to help them stay safe.

Risks related to allergy to foods or stinging insects include potentially life-threatening reactions. Symptoms such as hives, swelling, nausea and shortness of breath can occur. Feelings of the throat closing or dizziness and passing out are particularly of concern. Those travelers with food or insect allergies should always carry an injectible adrenaline, or epinephrine such as EpiPen or TwinJect. Be aware that documentation or a prescription may be needed to carry these and other medical devices on a plane or to other locations. The group planner should know how these devices work.

“If you have a food allergy, don’t rely on the tour director to handle the matter for you,” writes Robert Haru Fisher, a travel columnist and editor who contributes to the group travel blog at IAMAT’s Web site. “Have your allergy warning printed up on a card (preferably in the language of your destination) and show it yourself to the head waiter before you are seated. Ask to see the chef, enlist the tour director and/or guide to help you interview the chef about your allergy.”

Not for everyone
Whether or not to travel is a decision that can only be made by the person with the illness in consultation with his or her doctor.  “It’s sad for some people to want to go and not be able,” says Marcolongo. “Sometimes you have dreams and they cannot be fulfilled. That’s the problem with chronic illness. We must be able to accept limits.”

Larry Anderson

Group Travel Planet

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