How to Travel Comfortably with a Chronic Illness

The thought of taking a trip may be daunting if you have diabetes, heart disease, lung problems, arthritis or some other chronic medical condition.

Will I be uncomfortable or get sick during my trip? These common concerns can be easily managed—if you plan properly.*

Helpful: If you have diabetes, heart disease or another chronic condition, it's useful to wear a medical identification bracelet or necklace when you travel.“

Diabetes

If you have diabetes…

• Talk to your doctor about antibiotics. Traveler's diarrhea can be extremely dangerous for people with diabetes (due to disturbances in blood sugar levels, so your doctor may suggest that you start taking antibiotics before your trip-or bring antibiotics with you—if you are going to a less developed location where the sanitation is poor.
  

*To find a clinic near you that specializes in travel medicine, consult the International Society of Travel Medicine (ISTM). Go to the ISTM Web site at www.stm.org and click on "Global Travel Clinic Locator

**These products are available at American Medical ID (800-363-5985, www.American Medical-id.com), starting at about $30.

Important: Ask your doctor if the antibiotic you are prescribed is location-specific. For example, ciprofloxacin (Cipro) may be fine if you are heading to Central or South America, but resistance to ciprofloxacin is high in Asia, so azithromycin (Zithromax) is preferable.

• Review your insulin schedule. If you are traveling north or south (so there are no time zone changes) or traveling east or west through fewer than six time zones (typically the maximum time difference to which our bodies can adjust without causing significant problems)—there is no need to modify the timing of your insulin injections. But if you are crossing six or more time zones, discuss your insulin schedule with your doctor. Also, bring a glucometer with you so that you can check your blood sugar levels while traveling.
  

To avoid hassles at security: Before your trip, get a letter from your doctor stating that you must travel with a syringe or insulin pen. Otherwise, airport security officers might confiscate these items.

• Be careful with food. Obey the well-known axiom "if you can't cook it, boil it or peel it, leave it." Also take precautions with unpackaged loaves of bread to avoid bacteria from food servers' possibly unwashed hands. Just rip off the crust all the way around and consume only the doughy inside of the bread. Insist that your hot food be served steaming hot to help avoid dangerous pathogens and lower the risk for infections, which can worsen diabetes symptoms.
  

Heart Disease

If you have a heart condition, see your cardiologist before taking any long trips (lasting more than about eight hours) for personalized advice to help you avoid a heart attack, stroke or dangerous increase in blood pressure. Also...

• Don't fly too soon after surgery. Avoid air travel for at least two weeks following hospital discharge after chest surgery. During such surgery, air may be introduced into the chest to assist the surgeon. Any remaining air may expand in the body during flight, greatly increasing the risk of rupturing stitches.
  
• Find a specialist. Ask your physician to refer you to a doctor you can contact at your destination in case you have a heart problem. Be sure that you have up-to-date contact information for this doctor.
  
• Prevent blood clots. You may be advised by your physician to take an anticoagulant drug, such as warfarin Coumadin) or enoxaparin (Lovenox), before your trip to help prevent blood clots. Also, move around the airplane cabin or train (or take breaks from car travel) as often as possible. While you're seated, move your legs often (by 'walking in place" and flexing and rotating your ankles).
  

If you have a pacemaker, ask your doctor for a note that says you have the device-this prevents problems when passing through metal detectors at security.

Lung Problems

If you have asthma or severe chronic obstructive pulmonary disease (COPD)-obstruction of the airways due to empbysema and/or chronic bronchitis...

• Be aware of air quality. Areas that have high levels of air pollution can create breathing difficulties for people with asthma. Anyone with severe COPD should avoid visiting any destination with an altitude that exceeds 7,500 feet to help prevent shortness of breath.
  
• Ask your doctor about oxygen. If you have COPD and are unable to climb one flight of stairs without suffering shortness of breath, you may need oxygen during a flight. When making your reservation, ask the airline to provide in flight oxygen (you may need a note from your doctor). Call about 48 hours before your flight to confirm that oxygen will be provided. (Airline customers are prohibited from bringing their own on airplanes.) As soon as you are seated, ask for your oxygen a small tank with a face mask attached-and use it throughout the flight. Don't wait to experience shortness of breath.
  
• Bring inhalers on the plane. If you have asthma, be sure to bring your inhalers and any other asthma medication with you on the airplane or any other form of transportation you may take.
  

Osteoarthritis Or Rheumatoid Arthritis

If you have osteoarthritis or rheumatoid arthritis...

• Invest in high-quality rolling luggage. If you lug heavy bags, you're likely to inflame your joints.
  

Helpful: Pay a skycap to assist you...and pay the airline's extra fees to check an extra bag rather than wrestle with bulky carry-ons.

Be sure to take anti-inflammatory medication with you in case you become achy.

Helpful: Take your arthritis medication in advance to prevent joint pain if physical exertion is required, such as when climbing up the stairway to a plane that is boarded from the tarmac...or when transferring from a cruise ship to a smaller boat for trips to ports of call.

• Wear comfortable clothing and shoes. Everyone's legs and feet swell in the pressurized cabins of airplanes--but if your joints are prone to inflammation, swelling may prove especially uncomfortable.
  
• Move around as much as possible. To reduce soreness, take frequent breaks If you're in a car, or walk around the train or airplane cabin once an hour. (See the suggestions mentioned earlier for moving your legs while seated.)
  

Five Secrets of Healthy Travel

Some simple strategies can help keep you well especially if you plan to fly). These steps are useful even if you don't have a chronic medical condition. For example...

• Observe your seatmates. High-efficiency particulate air (HEPA) filters on airplanes are costly to run, so they typically are not turned on until an airplane has reached a cruising altitude. Even with air filtration, if your airplane seatmate is coughing, sneezing or showing other signs of illness and the flight isn't full, ask the flight attendant to give you a new seat.
  
• Drink water and try nasal gel. The dry air on airplanes often makes people feel dehydrated because the mucous membranes become dry, scratchy and irritated.
  

Helpful: Drink a glass of water every hour, and consider putting a dab of Ayr Saline Nasal Gel or Rhinaris Saline Nasal Gel (found at drugstores) just inside your nostrils every few hours to help reduce discomfort.

• Always carry hand cleaners. Use an alcohol-based hand sanitizer when you're away from a sink.
  
• Get up-to-date information on vaccines. Don't rely on travel agents. Their information is frequently inaccurate or out of date. Instead, ask your doctor and/or check the recommendations at the Web site of the Centers for Disease Control and Prevention, wwwn.cdc.gov/travel.
  
• Don't count on traveler's insurance. These policies often have loopholes that exclude the very medical emergencies most likely to arise if you have a preexisting condition. Before buying such a policy, read every clause carefully.