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Avoiding the medical complications of travelling

  • Monday, 16 March 2009 16:43
  • Last Updated Tuesday, 06 December 2011 00:34

General healthcare advice that is appropriate to all travellers often has particular relevance for those with Cancer, due to their increased susceptibility to the risks encountered. Often, relatively simple measures and precautions can prevent much distress.

Avoiding blood clots – The association between venous clots (thromboembolism) and long travel journies has been the subject of much speculation. Patients with cancer are much more vulnerable to clots and sitting in cramped conditions (car, bus, plane) for a prolonged period of time is likely to represent an increased risk. General advice includes

  • drink plenty of non-alcoholic drinks

  • avoid alcohol strong coffee

  • avoid getting dehydrated.

  • taking a short walk every 1-2 hours

  • take a brisk walk for a long as feasible before travelling e.g. in the airport before boarding rather than sitting around the departure lounge.

  • perform regular leg exercises

  • wear anti-embolic stockings (ensure they are fitted correctly)

  • unless contra-indicated (e.g. stomach ulcers or already on warfarin or heparin), 75 mg of aspirin should be taken the day before and the day of travel.

Some patients considered at a greater risk e.g. recent surgery, fracture, hormonal therapy or Chemotherapy it may be worth considered for prophylactic low molecular weight heparin with the GP, although this may raise practical difficulties.

Lymphoedema – Sufferers of lymphoedema may find their condition is exacerbated by travel (especially flying) as a result of prolonged inactivity. A pre-flight assessment by a lymphoedema specialist would be beneficial. Restrictive clothing should be avoided and compression garments worn as instructed. If lymphoedema affects the lower limbs the patient should be advised to wear shoes that can accommodate any swelling of the feet. Shoes should not be removed during the flight (there may be difficulty getting them back on). Some form of footwear should be worn at all times, including if bathing in the sea. If lymphoedema affects the upper limbs the patient should avoid wearing rings or wristwatches on the affected limb. The patient should also avoid carrying heavy luggage . Vaccinations should not be injected into the affected limb. Special care should be taken to avoid sunburn and insect bites. It may be considered necessary for the patient to travel with a supply of anti-biotics in the event of infection. The Lymphoedema Support Network produces an informative leaflet on the “Do’s and Don’ts” when planning holidays and travel (www.lymphoedema.org/lsn).

If you have previously suffered an episode of infection in the affected arm consider taking some antibiotics - just in case.

Avoiding diarrhoea and vomiting – Diarrhoea and vomiting can be debilitating to individuals who are generally in good health, but can be devastating to the patient with advanced cancer. If you are visiting an area with a high prevalence of diarrhoea consider asking your GP for a Single tablet of an antibiotic (a manoeuvre which has been shown to reduce the risk of diarrhoea). In general, in any country, food and water can be contaminated in a variety of ways but risks can be reduced significantly by taking relatively simple precautions:

If unsure about the cleanliness of the piped water supply, boil all water before drinking or cleaning teeth. For additional safety, only use bottled water (ensure that the cap is sealed) – fizzy water is less likely to have been tampered with:-

  • Avoid ice in drinks where cleanliness is in doubt

  • Avoid unpasteurised milk

  • Avoid foods which have been left lying about or reheated

  • Eat food that is freshly and thoroughly cooked whilst still hot

  • Avoid food that has been exposed to flies.

Taking care in the sun – Even limited exposure to strong sunlight can cause sunburn and heat exhaustion. Patients should be advised to stay out of the sun during the hottest part of the day (1100 – 1500hrs) and to drink plenty of non-alcoholic drinks. Some patients may be more sensitive to the direct effects of the sun due to chemotherapy regimes, Radiotherapy or lymphoedema. High-factor sun block (SPF 15 or higher) is recommended, as is the wearing of loose, cotton clothing. (also see careful sun exposure)

Insect bites – A number of countries have diseases that are transmitted through insect bites, but any bite can lead to subsequent infection. The risk of insect bites may be increased with certain types of holidays (e.g. camping), holidaying at certain times of the year (e.g. high summer), at certain times of day (e.g. at dusk) or at particular locations (e.g. lakesides, wooded areas). If the risk of insect bites is deemed to be high, the patient should be encouraged to use an approved insect repellent (preferably containing DEET (diethltouamide)) and keeping as much of their body covered with appropriate clothing. A “knock-down” insecticide spray may provide further protection. The use of a mosquito net should also be considered.

BT Buddies would like to thank Dr. Simon Noble, Senior Lecturer and Honorary Consultant in Palliative Medicine and Colin Perdue, Clinical Nurse Specialist for granting us permission to reproduce this article.

 


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