Coping with medical needs overseas

Annie and Fred Dintzis of Peoria, Illinois, sent in a request: “We’d like to know how travelers with medical problems cope in different locations overseas. Please solicit readers’ experiences, comments and tips on dealing with diabetes, various allergies, high blood pressure, etc.”

So we invited each of you to write in, using the following guidelines. Limit any experiences cited to those outside of the US. Along with any experience and the steps you took, include where you traveled and when your trip was (or when your most recent trips were). If pertinent, name the airline and the seating class you were in.

A number of replies were printed in the March and April ’11 issues, and more appear below. Have something to share? Write to Coping with Medical Needs Overseas, c/o ITN, 2116 28th St., Sacramento, CA 95818, or e-mail [email protected]. (Include the address at which you receive ITN.)

I have sleep apnea, a condition that requires sleeping with a CPAP (continuous positive airway pressure) machine. The machine provides continuous air delivered through a hose to a face mask.

I actually have two machines: one for home use with a humidifier and, for travel, a smaller one (six inches by seven inches by three inches and weighing two pounds). I have traveled the world with the smaller machine and have had no problems.

When traveling, the face mask (in a crush-proof box), the machine and the hose all go in my carry-on. I do not use the machine on the plane.

Getting the CPAP through airline security is usually easy. Most times, nothing is said; sometimes it’s checked for explosives, and sometimes I must explain what it is and assure the security guards that there is no oxygen involved.

When I arrive at my hotel, I set up the CPAP immediately so that any issues can be addressed. Most machines have dual voltage, so I need an electrical adapter, not a converter.

To get the machine plugged in, first I locate an electric outlet. I may move a table or unplug a lamp to get to it. Sometimes I move a bed or reverse the head and foot. Sometimes I have to request an extension cord. But I have always been able to connect the machine and use it.

In the last 10 years, I’ve traveled to Asia, Europe, Africa and South and Central America. I’ve used my CPAP in lodges, on riverboats and barges and in large and small hotels. The only exception was on an African safari, where the tented camp didn’t have adequate electrical power. I skipped using it those nights; it was only four or five days of a 16-day trip.

Please don’t let sleep apnea stop you from traveling to those places that call you to visit.

Lorraine Banfi
Jackson, NJ

My husband was diagnosed with a heart condition, atrial fibrillation, in 2003 and also uses a CPAP machine for sleep apnea. We have traveled overseas four times since then, on an 11-week trip to the UK in 2005; a four-week trip to Prague and Paris, including a river cruise, in 2008, and a six-week trip to Amsterdam, Madrid, southern France and England, including a river cruise, in March-May 2010.

Except for the two river cruises, we have traveled independently, which meant we didn’t have ready access to a doctor or other medical assistance, were there a problem. We purchase travel insurance for each trip and belong to Divers Alert Network, or DAN (Durham, NC; 800/446-2671), which offers medical evacuation coverage not only for divers but for nondivers.

Our medical insurance is with Kaiser Permanente, and before we leave we contact their Travel Advisory Service to see if there are any special health considerations we should be aware of for the locations we will be visiting. They are very helpful and make sure we have the appropriate shots plus Imodium and antibiotics for diarrhea or food poisoning.

Since my husband takes Coumadin (a blood thinner), which requires frequent blood tests, we also contact Kaiser’s anticoagulation clinic for a travel letter that authorizes the blood tests while we are out of the country.

This letter requests that the results of the test be faxed to the Kaiser office, and then they correspond with us via e-mail as to any changes in dosage. We have gone to the offices of private doctors and to emergency rooms for the tests. Usually, a private doctor will charge for the test, but we have found that emergency rooms generally do it for free.

We each carry a 3"x5" card listing all of the medications that my husband takes plus their dosages and the dates they were started or when the dosage was changed. We cover this card with clear packing tape to protect the information.

We each travel with one suitcase that is checked and one smaller carry-on that goes in the overhead bin or under our feet.

We always carry our pills in our carry-on. Depending on the length of the trip, it can seem like we have more pills than anything else in that bag. However, since pill bottles take up too much space in the bag, we repackage them into small zip-lock bags purchased from a jewelry/bead shop.

We request duplicate prescription labels from the pharmacy and put the label on the appropriate zip-lock bag. My husband also takes his first two-week pill supply in two pill trays that have daily pop-out pill holders. To prevent spilled pills, they are carried in a one-gallon zip-lock bag and refilled weekly from the supply of pills in the smaller bags.

When packaging pills, he always takes an extra week’s worth of pills, in case of travel delays or the occasional dropped pill. However, on the last trip he miscounted and ran out of a critical heart pill, so we went to a hospital emergency room to see a doctor. Fortunately, we were in England, so language was not a problem. After a bit of a wait, we saw a doctor and explained our problem and he prescribed the pill.

This was on a weekend, so we had to wait till Monday to go to the chemist’s. We submitted the prescription (it was a common heart medication) and they filled it by the end of the day. There was no charge for the ER visit or the prescription.

My husband always carries his CPAP machine on board the airplane. It is not counted as a carry-on, and the security people have been quite aware of what it is. He has not found it necessary to use the CPAP during overnight flights, so we have no information on how that would work.

The machine requires distilled water, and that can sometimes be difficult to find. In his checked luggage he packs one plastic bottle that is filled at home, and we shop for more once we reach our destination.

The distilled-water search has resulted in several interesting travel stories, such as the time in Prague when no one could understand what we were talking about. We visited several grocery stores and pharmacies, to no avail, until one pharmacist realized that she had sterile water. We purchased some in glass bottles, then poured the water into plastic soda bottles, which were much lighter and easier to pack.

We also pack an extension cord for the CPAP machine because the nearest electrical outlet might be clear across the room.

The important thing is to keep on traveling. Coping with medical needs becomes part of the adventure.

Nylah Chilton
McMinnville, OR

My suggestion to all travelers — take a list of all your medications printed on your doctor’s letterhead and signed by him or her. Be sure to include the generic names of each medication. Keep a copy of this list in your carry-on luggage but in a separate place from the medications, themselves.

Having this information in hand saved me a great amount of trouble when my purse was stolen by a very clever band of train thieves on a Prague-Vienna train in October 2005. The theft occurred before we had even left the station in Prague!

In addition to my passport, Hotel Sacher reservation confirmation, return plane tickets, credit cards, etc., my purse contained my prescription medications. However, in my carry-on bag I had my list.

We left the train and returned to our Prague hotel, and the concierge referred us to an international clinic. The doctor there read my list, wrote out a new set of prescriptions and directed us to the nearest pharmacy. The prescriptions all were filled without any problem (and, yes, everything was less expensive than it had been in the US).

Now I never travel abroad without my list!

Barbara Scruggs
Piitsburgh, PA

A very fine organization called International Association For Medical Assistance To Travelers, or IAMAT (1623 Military Rd. #279, Niagara Falls, NY 14304-1745; 716/754-4883), publishes a pocket-sized booklet that lists English-speaking doctors in most countries and major cities around the world, giving each doctor’s name, address, phone, mobile phone, website, e-mail address, etc.

The doctors charge set fees, ranging from $100 for an office visit up to $170 if the doctor comes to your hotel or it is at night or Sunday.

I’ve never had to use the services of any doctor overseas, but having this booklet handy gives me a great deal of comfort. As those of you who cruise know, ship dispensaries are okay for a hangnail or headache, but for anything more serious, you’d better seek a specialist.

I am 73 and my wife, 67, and we both have ongoing health issues that could need attention with little or no advance warning. My passport and my IAMAT booklet are the most important items on all trips.

Membership in IAMAT is complimentary, but modest donations are encouraged.

Dick Wallin
Rochester, IL

I suffer from celiac disease, the inability to tolerate gluten, so I have to avoid eating anything containing wheat, barley or rye. I have traveled extensively since my diagnosis in 2004, visiting France, the UK, Holland, Italy, Greece, the Czech Republic, Hungary, Slovenia, the countries of the Dalmatian Coast, Peru, Ecuador, New Zealand and India. My last international trip was Houston to London on Continental Airlines in September ’10.

Here are my travel tips for avoiding problems:

• Read everything on www.celiactravel.com, a website filled with useful tips. It has restaurant cards in 51 languages which you can print free of charge. These have been incredibly helpful.

• Many airlines offer gluten-free meals on international flights. Almost inevitably, these are poached chicken and rice or potatoes and either beans or cauliflower plus maybe a salad and some fruit. (Virgin Atlantic serves up vegetarian fare and British Airways usually serves fish.) They almost always lack any seasoning or taste, but on a long flight it’s food.

It’s worth checking with the check-in agent that the airline does, in fact, have your meal request. A couple of times there have been mix-ups, but each time the cabin staff came to my rescue, making up a meal from the first-class food.

• However, I usually pack my own lunch/dinner/snacks when flying.* I have a foldable lunch bag into which I can get two smallish, square, Glad-brand food boxes, and I typically make a salad. Potato salad and chicken or shrimp plus salad greens, tomatoes and cucumber works well; I toss it together when ready to eat. All this goes into my carry-on backpack, staying fresh enough until my flight out.

I have a three-ounce bottle for dressing, which I take through security in my quart-sized, zip-lock bag and then put into the lunch bag. In the couple times I was asked what it was, I got a smile when I told them, “Salad dressing.” I also take some fruit (grapes are the easiest), nuts and rice crackers. Don’t forget napkins and plastic knives and forks.

I haven’t had any problems with TSA agents or airline personnel (both domestic and international) in my extensive travels. They’ve never said anything about my food containers, except to comment that I’m eating better than the rest of the passengers!

I used to pop in a cold pack with my food, but a couple years ago I had a frozen gel pack confiscated at the Rochester, New York, airport. I’ve stopped carrying these ice packs now, but it’s a little scary that they had been routinely ignored.

• Into my checked suitcase, I usually pack extra nuts, rice crackers, small cans of tuna and triangles of processed cheese (which don’t require refrigeration) for those rare times when there is nothing I can eat. More often than not, they have returned home with me.

• Once I’ve arrived, I dig out my restaurant card in the appropriate language and make sure it is always with me. (I usually print out two or three, in case any get lost.) In restaurants where I can’t speak the language, I smile at the wait staff and give them my card. I have almost always been treated very well.

Chefs seem to relish the challenge of making a dish without flour or breading. Occasionally, I run across the truly clueless, but it is much more rare overseas than in the US.

• Countries that are really gluten-conscious are India (virtually no wheat flour is used except in the bread), Ecuador and New Zealand, where every restaurant has either a special gluten-free menu or a knowledgeable staff who know what I can eat.

Several of my non-European trips have been with Overseas Adventure Travel (Cambridge, MA; 800/493-6824). Their tour leaders have been marvelous, making sure that there is always something I can eat, even at the home-hosted meals that their trips always include.

To sum up, yes, it’s a royal pain to travel with this restriction, but if you read up on the problem, are vigilant and take some emergency food and those marvelous restaurant cards, you’ll have a great time.

Anne S.
San Diego, CA

*Regarding taking food through airport security checkpoints and onto your flight with you, the Transportation Security Administration states that all food must be wrapped or in a container so as not to spill and damage equipment or other passengers’ belongings. (Unpeeled natural foods, like fruit, do not require packaging, but half-eaten fruit must be wrapped.) All food must go through the security equipment.

Any liquid or gel-like food must conform to the 3-1-1 rule (it must be in containers holding no more than 3.4 ounces each, all fitting within one quart-size, plastic, zip-lock bag). The TSA classifies the following foods as liquids or gels: creamy dips and spreads (spreadable cheese, peanut butter, etc.); gravy; cranberry sauce; jams and jellies; soups; salsa; maple syrup; oils and vinegars; salad dressing, and sauces. Baby and toddlers’ food can be taken aboard if disclosed to the screening personnel.

A whole cake or whole pie is not on the “prohibited items” list but may be subject to extra screening or not allowed if it appears to have been tampered with or poses security concerns. Note: whether to allow or confiscate any item is up to the discretion of each screener.

There are multiple anecdotes/reports on the Internet of the following being allowed in cabins of both domestic and international flights, so long as the items are wrapped or in a container: baked goods (cookies, brownies, cake, etc.); crackers; chips; trail mix; sandwiches; pizza slices; fried chicken pieces, and individual-sized containers of fresh, prepared foods like meat dishes, casseroles, rice or salads. However, LARGE portions of casseroles, potato dishes, pasta, pies and food with soft filling (dumplings, turnovers, etc.) may be scrutinized and confiscated.

Note: all countries have restrictions regarding various food items (nuts, fruit, etc.), which might be confiscated by Customs upon entry.

The website http://contact.tsa.dhs.gov/mytsa has a page that offers information in four categories: “Can I Bring?” (lets you type in an item to see if it is prohibited or permitted), “Airport Status” (FAA updates on airport conditions or closures), “Security Wait Times” (post your airport wait time to a large database shared by others) and “TSA Guide” (rules and general tips, plus answers re special needs). For an iPhone, iPad or iPod Touch, a free application with this can be downloaded from http://apps.usa.gov/tsa-app or at the Apple iPhone app website.