High Risk Travelers

Question 1

Common chronic health conditions of travel

Answer 1

respiratory, i.e. asthma
Cardiovascular conditions – hypertension
Psychiatric conditions
Diabetes 

Question 2

Obese, travelers

Answer 2

Prejudice
Discomfort, embarrassment,


Question 3

Considerations for the chronically ill traveler

Answer 3

Destination, choice, transportation, mobility, travel, companion, access to medical care, and repatriation

Question 4

How travel affects illness

Answer 4

Med. Adherence, Jetlag, travel, anxiety, dietary factors, thermal extremes, and isolation from care.

Question 5

Air travel with pre-existing disease

Answer 5

Cabin altitude pressure is 25% lower than sea level
VT risk three times higher for long haul trips
Low relative humidity
Gas expansion enclosed spaces
Flight phobia, 10 to 40% of passengers
Emergency medical kit/AED/oxygen/diversions

Question 6

Medical care overseas

Answer 6

No or excess local phrases
English-speaking physicians available?
International Association of medical assistance to travelers
Travel insurance
Repatriation coverage 

Question 7

Cardiovascular stressors

Answer 7

Anxiety, delays, security, fears, stress, over exertion, heat/cold and alcohol
 air pollution


Question 8

Cardiovascular risk for MI 

Answer 8

Highest risk by far first two days and goes down through the trip



Question 9

Cardiac devices

Answer 9

Pacemakers, implantable defibrillators
- Consider electromagnetic interference
-Airport security
-Kari manufactures card

Question 10

Drug drug interactions with cardiac dz

Answer 10

Mefloquine and cardiac conduction issues
Aspirin
Beta blockers block warfarin
Diuretics 

Question 11

Travel with asthma

Answer 11

Avoid melatonin, it’s proof, inflammatory
Air pollution - avoid strenuous exercise
May perform well at altitude, unless particularly cold and exercise induced asthma
Don’t confuse HAPE with exacerbation of asthma 

Question 12

Travel and diabetes 

Answer 12

Plan ahead and bring travel companions to visit
Medicine letter may need to obtain insulin abroad as well 

Question 13

Air travel and diabetes

Answer 13

 don’t get the diabetic diet
Monitor frequently
Wait until you have food to inject insulin
Avoid dehydration
Get up and move wrong
Caution with stockings in case of PAD
Leaves shoes on 

Question 14

Travel and insulin

Answer 14

Adjustments only if crossing>6 time zones
No adjustments for north south travel
Eastward (shorter day)– avoid overlapping doses
Westwood travel longer day - likely need extra dose of rapid acting insulin and an extra meal
Oral meds unchanged
Insulin pump? Change clock at destination
Glucagon kit 

Question 15

High altitude and diabetes

Answer 15

Concern for AMS
Reduced daily insulin by 20 to 30%
Double carbohydrate intake
Well, worn in hiking boots
Blister plasters
Beware of falsely low glucose readings
Frostbite risk
Proliferative diabetic retinopathy
Caution, with acetazolamide

Question 16

Mental health and travel - benefits

Answer 16

Escape from routine
Time with family and friends
Exposure to new cultures
Opportunity to self reflect
Sunshine

Question 17

Mental health and travel – risks

Answer 17

 loss of routine,
isolation from social support
Culture shock
Too much introspection
Substance misuse