Friday, 15 Dec 2017

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TIPS for Arthritis Travelers (Best of 2015: #3)

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. Most of this is “art” rather than “science”, but all of it fills the needs of most when considering travel.

TIPS for Arthritis Travelers
The Rule The Rationale
Avoid or delay your travel if your arthritis/condition is doing poorly or uncontrolled. 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 as 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.
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.
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.

Ask your rheumatologist about meds you should (or shouldn't) travel with

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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, 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.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject
Dr. Cush is the Director of Clinical Rheumatology at the Baylor Research Institute and a Professor of Medicine and Rheumatology at Baylor University Medical Center in Dallas, TX. He is the Executive Editor of RheumNow.com and Co-Editor of the online textbook RheumaKnowledgy.com. Dr. Cush's research and interests include novel drug development, rheumatoid arthritis, spondyloarthritis, drug safety, pregnancy and Still's disease/autoinflammatory syndromes. He has published over 140 articles and 2 books in rheumatology.
He can be followed on twitter: @RheumNow.

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