In preparation of traveling to Medicine X, we had ePatient team physician, Dr. Rami Bailony, and ePatient Britt Johnson answer some commonly asked questions about traveling, and specifically traveling as a patient with a chronic condition.

What time zone should I take my medicine in?

Dr. Rami Bailony: For most medications (steroids, blood thinners, cholesterol meds, oral diabetes medications,etc), I recommend taking the medication per your activity routine in the travel time zone. So when you wake up, before you eat, etc.
For Insulin, adjustments to insulin doses are unnecessary if patients are crossing fewer than five time zones. Traveling east will shorten one’s day, and, in general, may necessitate a reduction in insulin (especially for shorter flights) because insulin doses would be administered closer than normal and thus could cause hypoglycemia. In contrast, westward travel means a longer day, and so insulin doses may need to be increased. However, this seemingly simple and workable rule of “westward = more insulin; eastward = less insulin” may not always hold true.
For antiarrhythmic medications, I would recommend taking your medication according to your home time zone (especially for short trips 3-4 days).

How many extra days worth of medication should I bring?

Dr. Rami Bailony: At least 2-3 extra days given chance of travel delays.

Should I ask my doctor for prophylactic meds? (A question from an RA ePatient on Twitter)

Dr. Rami Bailony: Yes, prophylactic meds are the way to go. In the case of RA, I would bring both pain meds and cortisone or prednisone burst. RA flares often erupt during stressful times and having access to your normal prednisone or cortisone 3-5 day burst could save you a lot of discomfort.
ePatient Britt Johnson: Work with your doctor, and discuss how traveling has affected you in the past, and what you might need (i.e. flare control, nausea medication). Preparing for adverse health events helps you to feel in control and less stressed if something does occur.

How can I best avoid germs on an airplane or in large crowds?

Dr. Rami Bailony: The best method for germ protection is hand washing. Beyond hand washing, there has unfortunately been no evidence based breakthroughs for preventing disease transmission (some trial with vitamin c, tamiful pre-flight) have shown mildly favorable results.
ePatient Britt Johnson: I bring a scarf or medical mask to shield from people coughing and also to block strong odors like perfumes and cigarette smoke that are triggers for my migraines. I also carry hand sanitizer for when hand washing is not immediately available.

If I’m having a bad disease day on travel day, how can I make travel easier? (Question comes from Twitter.)

Dr. Rami Bailony: Its hard to answer this question as it is disease dependent. I would discuss this with your primary care doctor and the best method may be to have prophylactic meds for your chronic disease ready.
ePatient Britt Johnson: Don’t be afraid to ask for help! All airlines offer disability pre-boarding free of charge, that you can request when you check in or at the gate. This allows you extra time to get on board, and if you need assistance with your bags or seat location, they will provide it. You can also ask for wheelchair or gate assistance at no charge. If you are having difficulty with any traveling service, Tweet them immediately! Most companies are very responsive and will immediately assist you.

How can I best keep up my stamina during the conference? (Question comes from Twitter.)

Dr. Rami Bailony: 1. Proper hydration (avoid under or over eating).
2. Take breaks (Medicine X is a marathon); it is ok to miss a lecture/session and go for a walk or coffee shop to get away from the crowd.
3. If possible, try to schedule time in the AM or PM for a massage, yoga, or other wellness activity.
ePatient Britt Johnson: Use the Wellness Room at MedX. This is a great place to find a quiet spot in a comfy chair, take a nap in a lounger, take medications in private, and stretch in a relaxed environment. This year’s Wellness Room was designed by a team of ePatient Delegates and Med Student Leaders.

How can I get better sleep when traveling?

Dr. Rami Bailony: Different methods work for different people.
1. Try to avoid naps beyond 30 minutes. Try to avoid going to sleep too late or too early. Push yourself to sleep at your normal
2. Consider melatonin (talk to your PCP).
3. Other sleep aids are person dependent, so talk to your PCP.
ePatient Britt Johnson: I travel with my sleeping basics, like chamomile tea and a heating pad. I also make sure and turn off all electronic devices at least a half hour before bed. When I do have trouble sleeping (which is most nights!) I listen to music, or use a meditation app like “Simply Being” to relax me.

What is the best way to deal with jetlag?

Dr. Rami Bailony: Same advice as above. Avoid naps beyond 30 minutes. Try to avoid going to sleep to late or too early. Push yourself to sleep at your normal routine time.
ePatient Britt Johnson: For me, taking a nap on planes usually helps ‘reset’ me, so I wake up in the new time zone. Eating meals during the proper time in the new time zone seems to help me, as well as short walks in the fresh air – which can’t be beat in Palo Alto!

What’s the best/most efficient way to get meds if lost/forgotten? (Question comes from Twitter.)

Dr. Rami Bailony: Get a hand written just-in-case script from your doctor before you leave. Easily the best way. Most doctors are willing to write an just-in-case scripts for most meds except for controlled substances.
ePatient Britt Johnson: In a worst case scenario (and this just happened to me), call your prescribing doctor’s office and explain the situation to them. They will usually accommodate you in the same day and call in or fax the prescription to a local pharmacy. Make sure you have the new pharmacy information on hand.  If you can not get through to your doctor, every office or hospital has on call physicians that should be able to assist you.

How can I best maintain my diet when travelling?

Dr. Rami Bailony: Set different goals for your travel. If you try to stick to your routine it might push you away. Try to maintain your diet as closely as possible.
ePatient Britt Johnson: If you have strict dietary considerations, bring as much with you as is reasonable. I usually travel with protein shakes and bars, in case I can’t find what I like at a local grocery store, and I don’t have to worry about wasting spoons (energy) on finding them.

Will my insurance work at local hospitals if I have an emergency?

Dr. Rami Bailony: Depends on the insurance. Most insurances cover emergencies after the deductible has been paid. If you end being hospitalized then you will want to ask to be transferred to a hospital that is within your insurance’s network to avoid any out of network fees.
ePatient Britt Johnson: Some insurance will not work while traveling, so it is important to confirm this with your provider prior to traveling. Relatively inexpensive travel insurance is available online, and will cover you in case of emergency.

Can I use disability pre-boarding when flying?

Dr. Rami Bailony: Yes, if your primary care physician approves.
ePatient Britt Johnson: I only use disability pre-boarding when I truly need it, if I’m having a bad day, or difficulty with my bags. Legally, they can not ask you about your disability, but I usually have a note from my doctor on hand just in case.

Are there any accommodations my hotel can make for me?

ePatient Britt Johnson: If you need it, most hotels have handicap accessible rooms available. Most hotels are able to put mini-refrigerators in your room for refrigerated medications. Don’t be afraid to call them and discuss your condition as you see fit with the concierge, they may be able to help in ways you didn’t realize!

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