For travelers living with a rheumatic disease, it’s best to plan and prepare, especially during the holiday season. Here are some things to consider:
1. Protect your joints: airports, luggage, and long rides
Do you have problems with your joints?
Joint pain is the most common symptom of rheumatic illnesses. Many of our patients have had joint replacement surgery.
Are your muscles weak?
This is also a common problem, especially if you protect a painful joint when you walk or use your arms or legs, so that your muscles don’t get exercise. Some medications, especially prednisone, will weaken muscles.
Do your medications make you sleepy?
If any of these questions are true, think ahead. Imagine every moment of where you will be as you travel. Can you sit in one position for a long time in an airplane or car? Can you get in and out of your seat? If not, make arrangements ahead of time to get up in the airplane or stop the car to stretch. What about the safety inspection and boarding areas? Can you carry or roll your luggage? Can you put it on a conveyor belt or take it off? Do you need assistance? None of these are impossible problems to solve, but you should think about them ahead of time and be prepared. Airplane companies will provide wheelchairs and porters to help you, as will most hotels and tour guides. Know if there is a fee for assistance, and know what you will or will not have to do. Before you sign up for that tour, be sure that you will be able to do all that the hiking or riding or climbing will require.
2. Customs and other issues
What medicines will you carry with you?
Customs officials may confiscate them if they have concern about contraband or illegal medications. If you use injectable medicines and carry bottles and syringes and needles, be aware. Mostly there is no problem- if you have with you a detailed doctor’s note that explains the medication, says how it is used and makes it clear (usually by giving details of your diagnosis) that you must take the medication. It is best if the doctor’s note offers telephone availability, if necessary, to discuss your needs. It’s even better if, in a foreign land, the note is in both English and the language of the country. That usually impresses the customs officials, and, in my experience, no one has ever called. Also, if your medicines have to be refrigerated, be certain that you prepare the appropriate packaging ahead of time and clear it with the airline. Some carriers have rules about what you can take on board. With the right information, they will usually accommodate your needs. If you have to take an injection during a flight, be certain that the airline is aware.
3. Doctors, hospitals, medications and maintaining contact
If your illness is in any way complicated, please ask your doctor to provide you with a letter (English is always OK, since you can almost always find an English-speaking doctor; translation helps) that explains your problem or problems, expected complications (if any), and, of course, all your medications. I often find it helpful to identify doctors or hospitals in the area my patient is traveling, and to give the patient the names and contact numbers. It’s best if I personally know the doctors; if not, the American College of Rheumatology membership list identifies rheumatologists geographically in most areas of the world; it is available online at https://ww2.rheumatology.org/directory/geo.asp (or www.rheumatology.org and follow the links).
If my patient is particularly at risk, I will invite him or her to telephone or e-mail me in the event of a problem. Not every doctor does that, but most will for specific circumstance, and having this kind of access can be very important. A telephone call and some emails saved the life of one of my patients who had a major emergency when she was in London (there was confusion about some of her laboratory tests and medications); another time I helped a patient get a critical medication she had run out of while in mainland China. An “I’m having a great time and am fine” e-mail is very reassuring to the doctor.
4. Vaccinations and illnesses (without and without immunosuppression)
Vaccination rules change frequently, depending on what is happening in various parts of the world at any time. The United States Government, Centers for Disease Control, maintains a website that gives current information regarding illnesses and requirements for travel in the entire world, https://wwwnc.cdc.gov/travel . For vaccinations, listed by country, go to https://wwwnc.cdc.gov/travel/contentVaccinations.aspx.
I have a few general rules that I tell my patients.
- You should be up to date on standard vaccinations, such as pneumonia and flu
- If you are taking immunosuppressive medication, you can take killed or synthetic vaccines, but you should not take live-virus vaccines. The injectable flu vaccines are killed virus; the aerosol flu vaccine is live. Check the CDC sites for details.
- If you are travelling only to large cities and civilized beach areas, you can usually skip the more exotic vaccines. If you are going into a jungle, however?
- It is usually worthwhile to carry a full dose of a simple, common antibiotic, with instructions from your doctor about circumstances in which it will be wise to take it.
- If you fall ill, especially in the first several weeks after your return, tell your doctor everywhere you have been. Some illnesses, like Lyme disease and Rocky Mountain spotted fever, occur in specific places at specific times of the year. Others occur in outbreaks, like dengue, Chikungunya fever, and Zika virus, recently in the Caribbean. All of these are carried by mosquitos. Please use insect repellents, wear long sleeves and pants, and try to avoid bites as much as possible when in these areas.
- A special case, Montezuma’s revenge (travelers’ diarrhea)
Unfortunately, diarrhea and travel are companions. To protect yourself, wash your hands frequently, especially after handling money, and, of course, be careful what you eat. If you get diarrhea, be sure to stay well hydrated, including taking enough salt. If you don’t have fever and don’t see blood, it will probably subside in a day or two. Usually something simple, such as Pepto-Bismol or Lomotil, will help- check with your doctor before you leave to see if you can take these. In most cases an antibiotic is not necessary; if you do take one, Cipro or Levaquin are most often used.
If you do have fever, see blood, or faint, you should contact a doctor.
But most likely you won’t need any of these warnings, so the only other instruction I will offer is this: have a great time!
Michael D. Lockshin, M.D., is Director of the Barbara Volcker Center for Women and Rheumatic Disease at Hospital for Special Surgery. He is the author of nearly 300 research papers, book chapters, and books, most on the topic of lupus, pregnancy, antiphospholipid syndrome and sex differences in disease