Travellers with chronic diseases

Written by Dr Charlie Easmon, specialist adviser in travel medicine

Travellers with chronic diseases

Many people with a variety of chronic diseases travel abroad, but certain circumstances, measures and limitations have to be taken into consideration.

Insurance details

The conditions of your travel insurance must be studied closely before you leave. Anyone suffering from any kind of chronic disease should, before setting out, check that the insurer will cover them.

Reading the small print can save much grief. Seek specialist travel advice from someone who knows about aero-medical medicine.

Many doctors just want you to have a good holiday without taking into account the complexities of your situation. It is never a good idea to lie by omission to an insurer since if they find out they will invalidate your policy.

Always take the medicine you need and usually take

All vital medication should be brought with you in your hand luggage, in sufficient quantities for the whole holiday, as experience has shown that your suitcase could end up at the North Pole, while you go to Morocco! It may well be possible to buy the medicine abroad, but it will often have another name.

The British Diabetic Association is clear in its advice that diabetic travellers should carry their insulin with them, as it can freeze in the hold.

Many countries have strict regulations on bringing medicine into the country, so a statement written by your own doctor in English saying that the medicine in question is vital and for your own exclusive use can ease your arrival.

This type of statement may help avoid imprisonment, or at least a lot of hassle. This is particularly true for the list below, which may not be recognised in certain especially restrictive countries (eg Thailand), where you may not be allowed to enter with these products regardless of the reason:

narcotics/morphine-based drugs (eg morphine, opium, or derivatives of them, as well as other strong painkillers).

drugs that stimulate the central nervous system, tranquillisers and sedatives as well as other, comparable products.

Different risks that affect travellers with chronic illnesses

All travellers, but especially those who are pregnant, or who have cardiovascular or lung disease, run an increased risk on long-haul flights (more than three to four hours) of developing blood clots in the legs or lungs.

This is, among other things, due to the decreasing space on planes, making movement difficult, and restricting blood circulation.

It is important to do pumping exercises with your legs at short intervals, and to take a walk up the aisle of the plane at least once an hour.

Economy class syndrome is increasingly recognised as a set of problems faced by the cramped air traveller who takes insufficient exercise.

If you have difficulty walking 50 yards on the flat without getting breathless, you are likely to have problems on a flight and are likely to require extra oxygen. This can be arranged in advance with the airline, usually at extra cost and they may require you to be accompanied by a medical professional.

Concerns about cabin air quality are currently being researched. More importantly, people with existing heart or lung disease may develop problems in heavily polluted cities such as Mexico City and Beijing. Altitude in places such as La Paz, Bolivia, may also be a problem for those with these conditions.

Wheelchair users, people with walking difficulties, and anyone with heart, circulation or lung disease should find out in advance about possible problems during transportation, transfer and at your destination (eg excessive differences of level, stairs, and access for wheelchair users and disabled persons). If advance warning is given, airlines will provide extra assistance and save you the long walks that occur at big airports.

Temperature and humidity at your destination should be considered before departure. If you cannot tolerate heat and humidity, then the East, for instance, is a bad choice of holiday destination.

Diabetics can request special diabetic food when they travel with a lot of airlines, but you also need to be able to choose what you eat after you arrive. Changing your food and physical activity will alter your insulin requirement, and similarly travellers' diarrhoea and feverish illnesses can mean that your diabetes gets out of control. You are advised to bring your equipment for testing blood sugar levels.

Finally, it is advisable to find out about the medical or hospital assistance available at your destination before you leave.

People with very serious illnesses (eg cancer or HIV infection), or people who may be expected to need acute treatment during their journey, are unlikely to be able to obtain a 'pre-travel health statement' in connection with an ordinary insurance policy. However, many can obtain assistance via support groups or other organisations.

All patients with chronic disease should think carefully about the medical facilities at their location. For example will a kidney dialysis patient be able to obtain efficient sterile dialysis facilities, or will an AIDS patient be able to receive suitable respiratory care or medicines?

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