A 22-year-old woman came to see me in surgery recently, complaining that her epileptic fits were getting more frequent. She had never taken treatment, as her fits had always been very infrequent, but now they were happening more often, and she was particularly worried that her epilepsy might scupper her plans to travel around the world. She agreed that her condition could no longer be ignored, and we discussed the need for her to get her epilepsy controlled with tablets, although she was concerned that she would not be able to get travel insurance with her illness.
Fortunately, insurance companies will often cover people with long-standing medical problems but usually only if these conditions are reasonably stable and properly managed. With most long-term medical conditions, patient support groups have managed to explain the consequences to insurance brokers, and negotiated travel cover. This may be at a greater cost than regular policies but it will cover any crisis including anything precipitated by the condition – in this case, a fit. For her the consequences could be dire. What if she fell off a cliff path somewhere or rolled into a fire or collapsed into a busy road? Especially as she intended to travel alone. I wonder what proportion of the 420,000 Britons affected by epileptic seizures risk travelling without insurance.
Stable epilepsy should not inhibit travel – indeed most good insurers are interested in the stability rather than the severity of any condition. For this reason, people who have recently ended up in hospital may find it more difficult to get insurance cover. Even without hospital admissions during the previous year or two, it may take some searching to find an adequate insurer. But there are sympathetic brokers and companies who realise that people with persistent medical conditions tend to look after themselves well, and perhaps even better than the average backpacker. Airlines too are permissive and only say that someone who has had a grand mal seizure in the previous 24 hours should delay their flight, so that restricts very few travellers.
People who have epilepsy, or a past history of epilepsy, have a limited choice of antimalarial tablets. You should avoid taking mefloquine (Larium) and chloroquine, since these two medicines can provoke seizures in people prone to fits. Find out which other prophylactics will protect you for your particular journey and then choose between the other brands. Malarone and proguanil (Paludrine) may be taken safely. If doxycycline is suggested, and you take carbamazepine (Tegretol), phenytoin (Epanutin) or phenobarbital (phenobarbitone) for your epilepsy, you need to take 100mg capsules twice daily which is double the normal dose. If Maloprim is suggested and you take phenytoin or phenobarbitone, it should be taken with 5mg of folic acid daily.
I am often asked in my surgery, “Am I fit to travel?” And people with asthma frequently express concern about whether they will stay well on their travels. If you have any kind of ongoing medical condition, this is a good question to ask your regular doctor. The medical insurance situation with asthma is the same as for epilepsy – agencies are not so much interested in what disease you have got, but how stable your condition is. Sometimes insurers will ask for a letter from a GP or consultant confirming fitness to travel. However some of the more canny insurers are realising what a pain this is to both patient and doctor and are dropping this requirement, since the fees that doctors charge for such certification are unpopular and can cost more than the insurance premium.
Asthma is a very common condition – it affects up to 16% of British children and perhaps 10% of British adults, although those figures may be an under-estimate. Anyone who has ever had an inhaler prescribed, or who has been told they are asthmatic, should be aware that travel might precipitate an asthma attack so it is best to be prepared: pack an inhaler. Travel is unpredictable, and so is asthma.
Sometimes asthma can emerge as a new problem, or a childhood tendency might return, for travellers going to congested big cities. Polluted Mexico City, at an altitude of 2,850m, is probably not a good destination for asthmatics or people with respiratory problems, for example. In well-chosen destinations though, many people with asthma improve, having escaped the pollen of temperate plants and the house dust mites of student digs. If you have ever been admitted to hospital with asthma you should discuss your travel plans with your doctor, who may suggest that you carry a course of steroid tablets.
Find out which treatments worked well for you during previous attacks. Do you know what triggers your fits? And find out exactly what medicines you are taking in case you need to buy more inhalers while you are abroad. Although salbutamol (Ventolin) and beclomethasone (Becotide) inhalers are available in many countries, proprietary names will be different and doses may vary so be careful. Many of the newer inhalers or devices will not be available overseas; you may have trouble getting refills for breath-activated products, and inhalers may not fit your spacer device. Take plenty, including a salbutamol (Ventolin) inhaler in your carry-on bag in case the stuffiness of the aircraft makes you breathless.
People who have suffered from asthma or any other disease for a long time, will usually know their condition well and, with a little forethought and planning, will be more than capable of taking care of themselves when overseas.
