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Air Travel and Your Health

Things to know about air travel and medical tourism

The affordable price of international air travel is an important component to accessing overseas medical options. There are some things to keep in mind when undertaking a trip on an airline to receive medical attention. Treat these guidelines as recommendations only, nothing should replace the individualized advice of your medical provider.

Cabin Pressure

The most significant aspect of air travel is cabin air pressure. To most of us there is no noticeable difference between ground air pressure and cabin air pressure. In reality most air cabins are pressurized to the equivalent altitude of between 6000 to 8000 feet (1828m to 2438m) although they fly at 30,000 plus feet. This increased pressure compared to sea level will cause a small decrease in the oxygen saturation of the blood and an expansion of gases in body cavities (abdomen, sinuses, ears). This is an important consideration in persons with heart or lung disease. This would be analogous to visiting a place like Flagstaff, Arizona (elevation 7000 feet) for the duration of the flight.

Lung Conditions

Persons with lung conditions like asthma and emphysema may be susceptible to the decreased oxygen saturation and should consider a preflight evaluation. A simple test of fitness to fly is the ability to walk 50-100 yards at a normal pace or climb one flight of stairs without severe shortness of breath. Persons with severe or unstable asthma or recent hospitalizations for the condition may be advised not to fly. It is important that medications (like inhalers and spacers) should be easily accessible in carry on luggage. Persons with emphysema may need medical oxygen therapy that can be provided by some airlines for a fee with advance notice if recommended by their physician.

Because of the cabin pressure of the equivalent to 6000-8000 feet altitude the heart has to work a bit harder than at sea level pressure. For most persons this is not a problem, but for persons with significant heart disease this may be a factor. Passengers who have a history of heart valve disease, angina, congestive heart failure or recent heart attack should be evaluated by their physician before travel. Medical oxygen may be advised in some cases. General guidelines for heart patients include:

• Carry sufficient quantities of cardiac medications for the entire trip and keep in carry on luggage.
• Keep a separate list of medications including name of prescribing physician with phone number, dosing intervals, and tablet strength in the event that medications are lost.
• Adjust dosing intervals in order to maintain dosing frequency if crossing time zones and be sure all medications are taken on schedule.
• Carry a copy of most recent ECG.
• Carry a pacemaker card if a pacemaker patient.
• Contact the airline if special diet, wheelchair or medical oxygen is required.
• Consider curbside baggage check-in.
• Limit walking, especially at altitude.

Surgical Patients

For surgical patients the managing physician should make sure that there are no complications, healing is reasonably underway and pain control has been achieved before air travel. After gastrointestinal surgery it is recommended that a delay of 7-14 days is made before air travel to ensure that all intestinal gas has reabsorbed appropriately.

Diabetes

For patients with diabetes it is recommended that all medications as well as needles, syringes, glucometers and snacks be brought in carry-on luggage. It is advisable that a note from a physician is obtained to explain the need for syringes and needles in flight.

Fractures

With fractures it is advisable to wait 3 days (72 hours) after the cast is set to avoid the risk of swelling.

Deep Venous Thrombosis (DVT)

Much has been said about the risk of Deep Venous Thrombosis (DVT). In some people prolonged immobilization (in any setting), clots can form in the leg that can be life threatening if they break off and travel to the lungs (pulmonary embolism). Ask your physician if compression stockings are appropriate. To minimize your risk all travelers are recommended to consider the following points;

• Do not place baggage underneath the seat in front of you because that reduces the ability to move the legs.
• Exercise the legs by flexing and extending the ankles at regular intervals while seated.
• Walk about the cabin periodically on longer duration flights and when flight conditions permit.
• Do not sleep in a cramped position and avoid the use of sleep aids.
• Drink adequate amounts of water and fruit juices to maintain good hydration.
• Avoid or minimize dehydrating drinks such as alcohol or caffeinated beverages.

Medical Records

For a safe and comfortable flight carry your medical records and medications in their original containers with the prescription label, Give yourself plenty of time to get through the airport. Wear loose fitting and comfortable clothes. Let the airlines know in advance of any special needs.

With reasonable planning and coordination with your medical providers a safe and secure flight can be a literal lifeline in your search for safe affordable world class medical care.