Traveling with Chronic Medical Illnesses

General Preparation: Practical Considerations

Although traveling abroad can be relaxing and rewarding, the physical demands of travel (e.g., maneuvering through a crowded terminal, rushing to catch a flight) can be stressful, particularly for travelers with underlying chronic medical illnesses. With adequate preparation, however, those with chronic medical illnesses can have safe and enjoyable trips.

The following is a list of recommendations for travel advisors to help those with chronic medical illnesses:

• Ensure that any chronic illnesses are stable. Persons with underlying medical illness should see their physicians to ensure that the management of their illness is optimized.
• Recommend seeking pre-travel consultation early, at least 4–6 weeks prior to departure. This is to ensure that there is adequate time to respond to immunizations and, in some circumstances, to try medications prior to travel.
• Provide a physician’s letter. The letter should be on office letterhead stationery, outlining existing medical conditions, medications prescribed (including generic names), and any equipment required to manage the condition.
• Advise travelers to pack medications in carry-on luggage in their original containers. Ensure sufficient quantities of medications for the entire trip, plus extra in case of unexpected delays. When crossing time zones, medications should be taken based on elapsed time, not time of day.
• Educate regarding important drug interactions. Medications used to treat chronic medical illnesses may interact with medications prescribed for self-treatment of travelers’ diarrhea or malaria chemoprophylaxis. Discuss all medications used, either daily or on an as-needed basis.
• Recommend consideration of supplemental insurance. Consideration should be given for three types of insurance policies: 1) trip cancellation in the event of illness prior to travel; 2) supplemental insurance so that money paid for health care abroad may be reimbursed, since most medical insurance policies do not cover health care in other countries; and 3) medical evacuation insurance (see the Travel Insurance and Evacuation Insurance).
• Help devise a health plan. This plan should give instructions for managing minor problems or exacerbations of underlying illnesses and should include information about medical facilities available in the destination country (see the Obtaining Health Care Abroad for the Ill Traveler).
• Recommend that the traveler wear a medical alert bracelet.
• Always advise the traveler about packing a health kit (see Travel Health Kits section).

Specific Chronic Medical Illnesses

Issues related to specific chronic medical illnesses are addressed in Table 8-9. These recommendations should be used in conjunction with the other recommendations given throughout this book. Additional resources for information include—

• American Heart Association: http://www.americanheart.org
• American Lung Association: http://www.lungusa.org
• American Diabetes Association: http://www.diabetes.org
• National Kidney Foundation: http://www.kidney.org
• Global Dialysis: http://www.globaldialysis.com
• Crohn’s and Colitis Foundation of America: http://www.ccfa.org
• U.S. Department of State: http://www.state.gov

Also, many international health-care facilities are accredited by Joint Commission International, an affiliate of the Joint Commission, which is the largest accreditor of U.S.-based health-care organizations. A list of accredited international facilities is available at their website, www.jointcommissioninternational.org (see the Obtaining Health Care Abroad for the Ill Traveler).

If travelers or their health-care providers have concerns about fitness for air travel, the medical unit affiliated with the airline is also a valuable source for information.

For Diabetes Specific information, refer to Diabetes at Work, School and Traveling.

Table 1. Special considerations for travelers with chronic medical illnesses

AICD = automatic implantable cardioverter defibrillators, CABG = coronary artery bypass graft, CHF = congestive heart failure, COPD = chronic obstructive pulmonary disease, CrCl = creatinine clearance, CVA = cerebrovascular accident, DVT = deep vein thrombosis, EKG = electrocardiogram, FSBG = fingerstick blood glucose, HD = heart disease, JCI = Joint Commission International, MI = myocardial infarction, PPIs = proton-pump inhibitors, TD = travelers’ diarrhea.

References

Deborah Nicolls Barbeau

• Aerospace Medical Association; Medical Guidelines Task Force. Medical guidelines for airline travel, 2nd ed. Aviat Space Environ Med. 2003;74(5 Suppl):A1–19.
• McCarthy AE. Travelers with pre-existing disease. In: Keystone JS, Kozarsky PE, Freedman DO, Nothdurft HD, Connor BA, editors. Travel medicine. 2nd ed. Philadelphia: Mosby; 2008. p. 249–55.
• Chandran M, Edelman SV. Have insulin, will fly: diabetes management during air travel and time zone adjustment strategies. Clinical Diabetes 2003;21:82–5.
• Simons FER. 9. Anaphylaxis. J Allergy Clin Immunol 2008;121(2 Suppl):S402.