Travel, holidays and insurance
Many stroke survivors will wish to fly at some stage and take holidays abroad. This section is a brief guide to flying, travel and insurance.
It is written in very general terms and will not be able to take everyone's circumstances into account. Please speak to your doctor before booking your holiday.
Flying after a stroke
The cabin environment on aircraft is different from being on the ground because modern aircraft can fly at altitudes of up to about 50,000ft (15,200m) above sea level, with most large aircraft cruising between 35,000 and 40,000ft (10,500 – 12,000m). the air pressure inside the cabin is lower ( about the air pressure at 8,000ft (2,438 m) ) and the amount of oxygen in the blood can drop. This does not cause problems for most people but may lead to low oxygen levels in patients with lung disease.
Longhaul travel is associated with prolonged periods of immobility, a recognised risk factor for deep vein thrombosis (DVT). This is of more concern to stroke patients who are already at higher risk of DVT.
When deciding on some ones suitability to fly, the following need to be taken into account:
- The urgency of the flight - is it for repatriation or a holiday?
- The nature and severity of the stroke and the interval from the stroke
- The presence of other problems like respiratory or heart disease
- The effect of lower oxygen levels and decreased air pressure in the aircraft cabin
- The effect of immobility
- The ability of the patient to cope physically and mentally with the stress of flying and airport check in
- Toileting and feeding
- The timing and accessibility of regular medication during long haul flights
- The ability of the patient to take up the brace position for emergency landings
- The need to be accompanied by a carer
- Health insurance cover
- Will the patients medical condition adversely affect other passengers or the operation of the aircraft?
At present, there is no standard advice available as there has not been any research done on the effects of flying after a stroke. General guidance can be obtained from the fact that Stroke victims have been repatriated safely within a week or two of stroke onset. The Aerospace Medical Association Guidelines (2003) suggest it is safe to fly once 2 weeks have passed after a stroke.
Airlines, however, have different guidelines to when they allow stroke patients to fly. The British Airways website states "If your symptoms are stable or improving and you feel well enough, you can travel after 3 days. Please talk to the Passenger Medical Clearance Unit (PMCU) if you have had a stroke within the last 10 days." Airlines may require the completion of a Medical Information Form (MEDIF), which is available from the medical department of the airline or a travel agent.
In general, medical clearance to fly is needed under the following circumstances (you and your doctor will need to complete a MEDIF):
1. Your fitness is in doubt as a result of:
- a recent illness (including stroke)
- a period in hospital
- you have an acute or chronic condition that is unstable
2. You need any special medical provision e.g. oxygen.
It is wise for anyone undertaking a long-haul flight to take sensible precautions such as to:
- Remain adequately hydrated
- Exercise the calves
- Spend periods out of their seat if possible
- Avoid excess alcohol
- Properly fitted compression stockings may be helpful
- Many stroke patients are already on aspirin and this may provide some protection
A stroke can affect a persons chance of getting good insurance cover. Many travel insurance policies may exclude pre-existing conditions or impose terms that are unacceptable. It is vital that you check with your insurer to confirm that any conditions you may have are covered. You have a duty to disclose any material facts to the travel insurance company.
This may include what pre-existing medical conditions you have. Other information needed will be medication details, further treatment details and anything else that may be at all relevant. Standard travel insurance may offer cover on request, for an extra premium, and sometimes with limitations and restrictions.
The alternative is to look for a specialist insurer who offer or can arrange specialist cover to people with illnesses. The Stroke Association have set up an insurance service for stroke victims called the Stroke Association Insurance Service. Other providers are also available and we would suggest comparing prices and cover before deciding.
Holidays and leisure activities
Maintaining leisure activities after a stroke and going on holidays will be very important for many stroke survivors. There may be some restrictions because of physical disabilities and cognitive problems but it is important to reassure stroke victims that activity will not result in a further stroke and many people find such activities very beneficial.
It has been shown that not participating in leisure activities leads to isolation, depression and adversely affects relationship with carers. Many stroke patients achieve fantastic feats of endurance.
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