What’s the best way to prepare for travel when you have chronic medical conditions?

Posted June 07, 2013, 2:00 am

In a few months, my husband and I are taking our first trip abroad. We both have chronic medical conditions. How should we prepare for our trip?

Many people with medical conditions enjoy foreign travel. But your preparation will need to involve more than just reading some guidebooks.

First, check in with your doctor. He or she may have specific concerns or advice for you. If you have diabetes, for example, your blood sugar level is affected not only by how much you eat, but by how much you exercise. And during vacations, both of these can change substantially. So ask yourself what the impact on your eating and exercise is likely to be from the vacation you have planned.

Since you’re traveling internationally, find out if you need vaccinations or preventive medications. You can check the Centers for Disease Control and Prevention (CDC) website (cdc.gov/travel), or ask your doctor. Try to get your shots four to six weeks before your trip, as some vaccinations need time to kick in.

If you take prescription medications, pack more than enough to last through your trip, in case your return gets delayed. And carry your medications in your carry-on bag, not in your checked luggage in case it gets lost. (The TSA makes an exception to the “no more than 3.4 ounces of liquids or gels” rule for prescription medications and necessary medical supplies.) That’s what I have done ever since, 20 years ago, I spent the first two days of a trip trying to get replacement medicines in a foreign country because my luggage was lost.

Also, carry a list of your medications, with both the generic and brand names. And bring along a doctor’s note if you have a pacemaker or other implanted device; you may need it when going through security checkpoints.

Get the name of a doctor or hospital at your destination. There are organizations on the Internet that maintain the names of English-speaking doctors with good reputations in many countries around the world. They also identify trusted hospitals. One example is the International Association for Medical Assistance to Travelers.

I can’t personally vouch for the quality and integrity of the doctors and hospitals linked to these organizations. I can say that many of the organizations have boards of directors populated by doctors affiliated with major U.S. academic medical centers. And check with your insurance to see what you need to do in case of an emergency.

If you easily suffer from motion sickness, take medicine in your carry-on bag. In addition, pack the following in your checked luggage:

antidiarrheal medication, a laxative and an antacid;antihistamine and 1 percent hydrocortisone cream for mild allergic reactions;cold medicine;medications for pain relief or fever;antifungal and antibacterial ointments;lubricating eye drops;basic first-aid items (adhesive bandages, gauze, elastic bandage, antiseptic, tweezers, scissors, cotton-tipped applicators).

With a little advance planning, you and your husband can enjoy a healthy and safe vacation.

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The Treatment of Overweight and Obesity as Chronic Medical Conditions

To begin our discussion, let’s discuss the current thinking about overweight and obesity. Physicians and scientists now believe that overweight should be considered a chronic medical condition. Practically, this means that we should consider treating our weight like we would consider treating ourselves if we had high blood pressure.

For example, if you found out you have high blood pressure, most people would first go to see their primary care physician. The primary care physician would check your blood pressure and likely start out by asking you to do a few things on your own to help the blood pressure like cut out salt and decrease alcohol use. At your next visit, if the blood pressure was still high, your physician would likely prescribe medical therapy for your blood pressure in the form of a high blood pressure pill. At your follow up visit , if your blood pressure is well controlled, your physician would refill your medicine and arrange the for future monitoring. If after several adjustments in medication your blood pressure is not within normal limits or if your blood pressure is severely elevated which can lead to organ damage, your physician would then refer you to another physician, likely a nephrologist, a specialist in blood pressure control. Your blood pressure specialist will use tools and medications that your primary care does not use everyday as the nephrologist has more experience with hard to treat blood pressure. If at any time, you were decide to stop treatment with your blood pressure medicine or to have a really salty meal, it is no doubt that your blood pressure would go up again.

Let’s use weight in the same example as blood pressure. When you first seek treatment for overweight or obesity, the first person to visit is your primary physician. Your physician may recommend a particular diet and exercise regimen. Like easily controlled blood pressure, this may be all you need. If your weight does not respond adequately (your loss is not enough) or if the diet is too hard to follow or you have been on it prior and had weight regain or you have multiple medical conditions that your current weight is worsening like diabetes, high blood pressure or sleep apnea your physician should send you to a specialist in weight loss called a medical obesity specialist (see www.ASBP.org or www.ABOM.com). This physician is well trained in comprehensive medical weight loss and will use techniques not well studied or known to your primary care physician.

To treat our weight any other way than as a chronic disease (like blood pressure) would be to go against current medical and scientific thinking. Aggressive low calorie diets, exercise, behavioral modification and medical oversight including various weight loss medications are the current best known way to lose weight, and give you the best known way to keep it off. When you are successful in using dietary change, weight loss medicines, exercise and behavioral methods to lose weight, if you stop dieting, taking your weight loss medication or exercising, it is likely that you will regain your weight.

It is unfortunate that at this time we do not have a true cure for obesity. Medical science is continuing the pursuit for a cure. Until a cure is found, we will have to use comprehensive approaches to lose weight and continue these treatments for long periods of time to prevent regain.

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Drug Shows Promise for Lupus Skin Conditions

BySalynn Boyles
WebMD Health News Reviewed byLouise Chang, MD

Dec. 7, 2012 -- A drug related to thalidomide may be more potent and less toxic than thalidomide, which is often used to treat lupus skin conditions.

In a small study from Spain, lupus patients showed dramatic improvements in skin lesions while taking the drug, lenalidomide (Revlimid), and most relapsed soon after they stopped taking it.

Thalidomide’s Infamous Past

Thalidomide is best known as the drug that caused thousands of children to be born with missing limbs and other birth defects in the late 1950s and early 1960s.

In more recent years it has been brought back to the market to treat a number of serious conditions, but its use is monitored closely to ensure that it is not taken by women who are pregnant or who might become pregnant.

Dermatology professor Andrew G. Franks Jr., MD, of the NYU Langone Medical Center, says thalidomide is very effective for treating people with lupus skin conditions who do not respond to standard treatments such as steroids and antimalarial drugs.

He says about 75% of patients with affected skin will go into remission with these standard treatments.

“The question has been, ‘What do you do with the rest?’” he says.

Franks says thalidomide can help an additional 75% of patients achieve remission. But side effects are common and some, including nerve damage in the hands and feet, can be permanent.

Lenalidomide Highly Effective in Small Study

The lenalidomide study included 15 women with lupus skin conditions; six had lupus in other areas of the body, too. They all were followed for seven to 30 months.

All had received standard treatments, and 14 had been treated with thalidomide previously.

The majority of the patients (60%) had the most common subtype of lupus-related skin disease, known as discoid lupus erythematosus, which is characterized by red, scaly patches that can scar.

One patient withdrew from the study after one week due to digestive system side effects. All the other patients showed improvement, and the rash cleared up in 86%.

The researchers note that the study dose was “generally well-tolerated.” No new nerve symptoms were reported.

Similar to treatment with thalidomide, most of the patients had a relapse of their skin problems within weeks of stopping the drug.

No Progression to Full Disease

Several earlier small studies raised concerns that treatment with lenalidomide may be linked to an increased risk of progression to full-blown lupus, not just lupus limited to the skin.

Josep Ordi-Ros, who led the Spanish study, says this was not seen in the latest study, which was published Dec. 6 in the journal Arthritis Research & Therapy.

But Cynthia Aranow, MD, of the Feinstein Institute for Medical Research in Manhasset, N.Y., says larger studies will be needed to determine if the drug is truly safe and effective for patients who do not respond to other treatments.

She adds that the drug appears to have a similar risk for birth defects as thalidomide, so it will need to be monitored just as carefully.

“There are many questions that remain,” she says.

Lenalidomide is available as Revlimid to treat people with multiple myeloma and myelodysplastic syndromes. According to the manufacturer’s site, the cost of Revlimid at the doses used in this study would be about $440 a pill.

View Article Sources

SOURCES:

Cortes-Hernandez, J. Arthritis Research & Therapy, Dec. 6, 2012.

Andrew G. Franks, Jr., MD, director, Skin, Lupus & Autoimmune Connective Tissue Disease Center; clinical professor of dermatology and medicine (rhematology), NYU Langone Medical Center, New York.

Cynthia Aranow, MD, researcher, Feinstein Institute for Medical Research, Manhasset, N.Y.

News release, BioMed Central.

Revlimid web site: "Information for Prescribers of Prescription Drugs."

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