Travel can be difficult for patients with arthritis. In addition to weakness or mobility problems, patients have to contend with issues ranging from TSA rules, injectables, medication handling, fatigue, sleep problems and the risk of flare or venous thromboembolism. Below is a set of common rules that have worked well for my patients over the years. These recommendations are based on experience and study, but you should consider the recommendations below when considering travel.
|TIPS for Arthritis Travelers|
|The Rule||The Rationale|
|Avoid or Delay Travel if your Doing Poorly||Travel can be stressful, physically demanding with lots of walking, lifting, standing or sitting for long periods. The further you are from home, the greater the challenges you may experience, and the fewer resources you will have to manage them.|
|Step-up or increase arthritis meds when you travel||Consider taking an extra pill on the days you travel. If you rarely or irregularly take arthritis or pain meds, you can avoid travel related pains by adding another pill to your usual doses for a day or two. Hence on the day of and the day after travel you should take an extra arthritis pill (such as Tylenol, prednisone or Advil.). Ask your doctor what med would be best for you to increase when traveling.|
|Travel smart. Be prepared for arthritis flares, lost meds, accidents or emergencies.||Always bring your meds (even if don't take them daily). Pack a few extra days’ worth of your usual meds along with a copy of your medicine list, last Doctors Note and your doctors and pharmacy phone numbers.|
|Meds should be part of your “carry-on” bag. A doctor’s note isn’t needed to get meds thru airport security.||You should pack labeled prescription bottles, pill organizer, syringes in your purse or carry-on. Pack snacks to take pills with. TSA only requires you prove the medication is yours. Your proof is the label on your prescription bottle or box. Carry your meds on you and apart from checked luggage.|
|Plane travel: Pack Smart and Pack Light||Read up on how and what to pack to reduce your baggage. Tip someone to carry your bags and check your luggage. Don’t be a martyr: Ask for wheelchair or electric cart to the gate or around in the airport. Exercise on plane by stretching, doing shoulder and ankle circular movements; move legs as if bicycling. Contact the airlines ahead of time with questions about getting around, TSA & security, getting on and off the plane, etc.|
|Car travel:||Stop every 2 hours to walk, stretch and move. Prepare the car for comfort. Bring pillows, ice chest, and water. Do shoulder & ankle circles; move legs as if bicycling.|
|Deep Vein Thrombosis (DVT) Prevention||DVT are common complications of travel. Those at greater risk are people with a prior DVT or pulmonary embolism, hip joint or knee joint replacement surgery, obese, smokers, pregnancy, birth control pills or estrogen therapy, cancer, heart failure, and prolonged sitting or flying. You can prevent DVT by wearing compression stockings (if medically indicated), moving, stretching your legs, doing calf contractions, getting up every 1-2 hours, avoiding dehydration or alcohol, and avoid crossing legs. Most people do not benefit from aspirin 81 mg or blood thinners unless prescribed by your doctor.|
|Injectable medications: Either take before or after the trip OR take as a carry-on||It is safe and wise to take your injectable (i.e., Enbrel, Humira) a few days before or a few days after your trip. Ask your doctor about the best timing. If you must travel with injectable, there is no need to bring an ice chest for refrigeration. Wrap your injectable syringe in bubble wrap, put in your purse or briefcase and bring the box label. Once you are at your destination you can store it in a refrigerator or minibar. The syringe is safe on planes & hotels as long as they are at room temperature, away from sunlight or heat.|
|Know the Terrain & Plan Ahead||Prioritize activities, alternate activity & rest times. Call travel agents, airlines and hotels about what to expect as far as the physical layout - how much walking or stairs; are they handicap equipped; is a doctor nearby? Ask for a room by the elevator.|
|Protect Yourself||Carefully choose your clothing and diet when traveling. Use a sunscreen (at least SPF30). Bring hats, long sleeves, and rubber soled shoes or shoes with good shoe inserts.|
|Allow more time||Rushing and being hurried leadss to either stress or pain. How much time? Normal time and then add a proportional amount for your mobility, disability, # of bags & more if you need a wheelchair. It may take a business man 20 min. to get through security and to the gate. It may take you 30-40 minutes to do the same.|
|Plan for Rest After||Travel is stressful and far more taxing than most people imaging. Travel that involves airports will add 2000-6000 more steps to your day. Changes in altitude and time zones will result in fatigue and more aches if you have arthritis. Plan to rest immediately after your travel. The longer the travel, the longer the recuperative rest that will reinvigorate you.|
See your doctor(s) before you travel. Ask them about meds you should (or shouldn't) travel with or other specific limitations or recommendations)
Travel to High-Risk TB Countries: If your patient travels to a high risk endemic area for tuberculosis (see CDC http://buff.ly/1J0w90F), then post travel TB testing should be considered. This is not necessary for most tourists, but should be considered if the visitor is in close contact with sick individuals, poor living conditions, prisons or doing medical relief work. The usual protocol is to administer a PPD (TST) or IGRA (i.e., Quantiferon) 2 weeks after return from their potential exposure.
What about Travel to Places Where other Serious Infections are Endemic (Coccidioidomycosis, Histoplasmosis, Chikungunya, Zika, etc.)? As there are no reliable “screening” tests for most opportunistic infections the clinician must manage and assess the patients with: a) heighted suspicion and b) observation for signs and symptoms that may indicate such an infection. The best measure may be prevention where possible (e.g., long sleeves/pants, bug spray, hats, condoms [some of these can be sexually transmitted]). Women who are pregnant should not travel to the Caribbean or countries where the Zika virus is an active problem.