Hi everyone. First post here. Had surprise NSTEMI in May 2023 (no apparent prior signs). Two narrowings in Left Circumflex and a blockage in RCA identified 2 days later in angiogram with immediate placement of 3 stents. On dual antiplatelet treatment (aspirin & prasugrel), with bisoproplol, ramipril and atorvastatin. Have made a good recovery thanks to Cardio Rehab team and follow on support from GP, as well as daily exercise and big change of diet.
Now thinking about summer family holiday when I will have come off the prasugrel. My wife is from Sri Lanka and we have not visited since 2016. I am wondering about the wisdom of making the long flight (12 hours) to stay 4 weeks in a fairly remote part of the island in a very hot and humid climate for 4 weeks. Has anybody done such a holiday? Medical facilities are not the best even in larger urban areas. Worried about another HA and being unable to get to specialist treatment in a timely manner. Is it wise to take such a trip for such a duration to such a climate and location? Are there implications also for the meds in such circumstances? Any advice on specialist travel insurance if it is ok to travel there? Any observations or reflections would be gratefully received.
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Pcicad
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You ask a good question, and it's one that I've wrestled with several times.
Following a heart incident we all face the trade-off between living the life we want, and denying ourselves life-affirming experiences in order to minimise risk.
There's no right or wrong answers, but for what it's worth here's how I've squared this particular circle.
There's no escaping from the uncomfortable fact that surviving a heart attack or stroke depends to a great extent on receiving specialist and expert treatment in the shortest possible time. And 30,000 feet up in the air, mid way across an ocean, would inevitably add hours in the event that the worst happened.
However, I don't believe that the act of flying in itself materially adds to our risk. Certainly I've been unable to find any solid evidence that more heart attacks occur in the air than on the ground.
In addition I personally take a more holistic approach to risk. I do things that materially reduce my risk (weight loss, regular exercise, healthy eating, no nicotine, etc), but having banked these "risk credits" I allow myself to make some withdrawals from the risk bank with long haul flights, cruises, and off-shore yachting.
In your particular case you have the added reality that for your wife to occasionally visit her family in Sri Lanka is of fundamental importance to her well being.
Put all that into the pot and if it were me I'd go.
I'd still want to mitigate risk wherever possible, so I'd double down on life style changes before, during, and after the trip; I'd also discuss it with my doctor and further reduce risk with everything from compression stockings to in-flight exercises and mindfulness programmes. I may also try to reduce the time in rural Sri Lanka and spend more time closer to larger towns. But having done all this, and more, I'd conclude the benefits exceed the risk and I'd be dusting down my passport!
Whatever your choice, I wish you the very best of luck!
I would concur with this fulsome reply. I've done 7 week visits to NZ in 2022 and Australia in 2023. I am also mindful of managing triggers eg avoiding heat of the day avoiding sudden changes in temperature such as happens when walking into a cold wind (for me) and being sensible by wearing a hat, using sunblock SPF50 and keeping hydrated. I've even managed to do several Parkrun in both NZ and Australia on my visits.
Hi, indeed a good question and I think Chappychap has given an excellent reply.
I don’t have any issues travelling or flying (short or long haul). I love travel and have been determined not to let my condition effect this.
I was diagnosed with an arrhythmia (PAF) in 2019, following a heart attack (NSTEMI type 2 ). All of this was out of the blue with the arrhythmia being the chief suspect for a small transient clot. An angiogram showed no occlusions ( no stents required) and I was discharged on medication and exercise.
This curtailed travel for a few years after that, including the pandemic period but now I trying to make up for it.
I am fortunate my PAF is well controlled (no episodes for years) with daily medication (Flecainide) and I am very fit and healthy. The heart attack left me initially with slight left ventricular dysfunction but with a robust approach to rehab, this has been mitigated. My heart is now structurally normal and I can maintain a high exercise tolerance again (like before my MI).
I feel pretty confident and the main thing for me is avoiding irritating my PAF. For a long haul trip/flight, I ;
- try to remained chilled at all times. Hiccups happen on trips but just deal with them when they occur.
- stay hydrated and avoid too much alcohol but hey! I’m on holiday, and a beer or wine with a meal is usually fine.
- eat but I never over eat or eat too late. Tricky sometimes on a flight changing timezones but I manage it. Eating late and being over full is generally not good for me anyway; something I avoid.
- to try and avoid jet lag, I always adopt the time zone of my destination as soon as possible.
- get some sleep / relax in tune with my destination.
- medication. I am on twice a day medication - 12 hours apart. Normally, I set a 12 hour timer on my watch after my last dose in local time. It is then just a bit trial and error were I blend my timings to reflect my destination +/- a few hours depending on the situation. This is very much a personal approach, I am sure others may do it other ways but it works for me, so far.
Then there’s just general things.
- good travel insurance - make sure all conditions are covered; declare everything.
- check destination’s law/rules (volume and restricted meds) on importing medication and adhere to it. As a minimum, I take my last prescription and enough meds for trip in their original labelled dispensing packaging. I carry a supply for the whole trip plus spare in hand luggage.
- research medical facilities at destination and have a plan.
- a good personalised first aid kit - ability to deal with typical traveller ailments in the tropics.
I should mention that everything has been discussed with my cardiologist too, in particular plans for dealing with my arrhythmia.
Clearly travelling is a choice, taking into account your personal circumstances and appetite for risk too. Only you can judge your personal state (both physical and mental); don’t rush things either. For myself now, I feel I have stability and I’m currently confident about my medical situation. In 2022, I ventured into Europe again and last year headed out to Singapore and Borneo. For the latter, I was in middle of the rain forest, for example. It was remote and clear that good medical facilities were a few days away, I knew this but ……but I wanted to visit that national park.
My wife and I are ‘debating’ our plans for this year. Sri Lanka has been mentioned too. We visited once prior to my heart attack and would like to discover the Northern and Eastern regions. Personally, I’d have no qualms about visiting, though the country has had some difficulties in the last few years. I’d make sure I have supplies of my required medication , as local supply might be difficult and at least thought about how I’d get back to Colombo in a medical emergency.
Thanks so much. Very helpful. Interested to see reference to your visits to Singapore and Borneo. It’s the continuous high temperatures and high humidity and the effects these may have that are probably of most concern to me for a visit of up to four weeks (because of family). Thanks again.
Hi, yes, it is difficult to determine and I imagine it is a concern but only you can address it. You know what you are like, on a day by day, week by week, month by month basis. I think its just a case of making an honest evaluation of ourselves, based on current and previous experience - not forgetting any medical guidance too.
For me, prior to my MI/Afib diagnosis, I’d been to hot or tropical places plenty of times before and I was always ok but how would I react now. To be fair, I had a couple of years to figure it out before I got to this point, with travel stymied by the pandemic.
The key indicators in my decision making:
High exercise tolerance - this was singularly one of the most important factors. I know my cardiovascular system can take some stress, borne out of lots of hours on a treadmill and confirmed with CPETs. I noticed you mentioned Cardiac Rehab, I still regularly attend sessions and attribute a lot of my recovery to it.
Stable - my Afib is very stable (no sustained episodes for years) and well controlled by medication.
Backup plan - I have an ‘emergency PiP’, should an episode occur, I can take extra Flecainide and a beta blocker to help nudge my heart back into NSR. To date, I’ve never had to use it and if travelling, this would either hopefully revert me or buy me more time to get medical assistance.
Then it’s just the usual things on a trip - rest when you need to, sleep, eat, keep hydrated and don’t stress; enjoy yourself.
In all honesty, I still have my moments though, the key is not to panic. While in the jungle I had some ‘chest discomfort’ but I was hiking up a 60 degree muddy path with 100% humidity and 36c. Initially it made think what’s was going on here but then I rationalised it’s something id felt before time and time again = sheer exertion. Pre and post MI, if I’d been cutting contours and lugging climbing kit up to a crag in Lakes, I would have felt exactly same. I was fine and the trip was great.
There are quite a few threads on here re:travel insurance (which basically say, prices vary person to person, no one size fits all, so shop around) but I would add a recommendation that you check out the packaged bank account products when you shop around. As an example, Nationwide has a packaged account for £13 a month, so £156 a year, that provides family worldwide travel, mobile phone insurance and breakdown cover. They quoted about £250 a year additional premium to include my conditions. For me, this was considerably more than just buying a few single trip policies for European travel, but considerably less than a single trip policy long haul. In fact it was almost half the cheapest single trip price I could find for a holiday to Mexico and gave me annual cover.
I think before you go any further you need to see if you can get travel insurance. If you can't get it, forget the trip. If you can get it that would suggest that experts have assessed your condition and are willing to take the risk of insuring you.
However they can't factor in the very long flight, the remoteness of your location nor the heat and humidity. Please read up about the effects of these weather conditions as they do affect the heart.
I would also run this past your medical team. Are they happy?
Try justravelcover.com where by inputting your details you will get a number of quotes. Do come back to this forum and let us knw how you get on.
As regards travel insurance, I found that two years after my HA (four stents) it became easier to obtain and cheaper. It appears the underwriters like to see that your condition is stable and that your meds are periodically being reviewed.
I have an annual policy with Sainsbury’s Bank, as I’ve had my motor and home insurance through them for some years. I’ve just turned 70.
Back in 2015 I had a STEMI and cardiac arrest. They sorted me out immediately with some stents and discharged me 3 days later.
After a few weeks I went to cardiac rehab. Six weeks after my STEMI I went on a prebooked holiday to India - long flight and very hot weather. It was fine.
Since then I’ve spent a large part of every year in a remote area of West Africa. Also very hot and humid and with virtually no nearby medical facilities. My priorities are to live my life fully however long or short it may be.
Everyone has to decide their own attitude to risk. My view is that we are better off having had our stents and medications to deal with our disease.
But as everyone has said, make sure you get good travel insurance and declare anything relevant.
Lots of good advice and I too have done long haul since the worst of Covid. One thing I always consider too, is the effect on those travelling with me. If I had an incident or a covid infection then my wife would suffer more than me in a country where facilities weren't great and the language was an issue.
I didn't do a previously regular trip to the States with my son, because I didn't want to put him in that position.
Good to hear your recovering well, same happened to me 4 years ago now 4 stents, normal medication etc did the rehab which was excellent in helping with the recovery.
I was 57 no previous issues, never smoked and reasonably fit not over weight, work, life stress we think the cause.
Ref the holiday all I can say is go for it, relax and enjoy. I was very nervous at first and 8 weeks after the HA we went on holiday to Dubia just to relax and sort my head out. Health wise I was fine, just in my head the normal spinning and anxiety was there. All good however and felt so much better when in the holiday mood. I still get a little nervous but once on holiday that soon goes away. Also off to Sri Lanka in February this year.
Yes take all the information in, get into good habits, diet and exercise.
Reference travel insurance, lots out there but the most important thing is to make sure you carefully complete the medical declaration. Be careful with the free, or monthly bank policies unless they request completion of the medical declaration. The question set is mostly the same with most companies. I personally used a company called All Clear, or walk in and speak to a local Insurance Broker.
I can only add to what many others have said with regards to a decision balancing your personal life needs and the need to access first class healthcare when you need it. In the end, travel insurance provision aside, only you can make that call, since you know your personal circumstances the best and the facilities at your destination. As far as the flight is concerned you could discuss that with your GP, although I suspect the risks are not going to be too critical to your decision. As far as travel insurance itself is concerned first if you have any upcoming tests or investigations that will restrict your choice, on either cost or providers deciding to decline, and second your HA is within the 3 or 5 year period that providers normally ask for regarding recent HAs, and that to may also restrict your choice. I suggest you go to a site covering travel insurance with pre-existing medical conditions, punch in your details and see what that throws up. At least then you will get an idea of what the travel insurance situation is like for your own personal circumstances.
I had a HA in April and a CABG in May, I have since done a Med cruise and week in Cyprus. Now booked a 4wk holiday in Australia after getting a new insurance policy. World wide policy with nationwide was only £100 more than we were paying before so guess they don't see me as a high risk. There is always a risk but my view is Iam in a better place post op on meds than before, so I am getting on with life.
I had a HA and Stent fitted end of July. On numerous meds a d competed my recovery plan with the team. Less than month's later I took a cruise to the Caribbean for 2 weeks and it was all good. Heat and humidity was a challenge but so is the cold right now in the UK. As long as you take care of yourself and stop when you feel you need to, have your meds and GTN spray there is no reason not to go. My flight to Barbados was 8.5hrs.
Hi I’ve read through the replies to your question as I’m in a very similar place. My HT and 4x CABG was 18 months ago and every time you do something new that you took for granted before your mind just spirals out of control. Last year we spent a month in Germany even though I knew there would be no medical issues as the hospitals are fantastic over there.
Well my mind is all over the place at the moment we’ve booked to go to the Maldives we have to fly to Dubai then to the Maldives followed by a 30 minute sea plane to our island which is so small you can walk all the way round it in 45 minutes.
If something happens to me that’s it I’m dead but life has to go on, what’s the use of being here if we can’t enjoy our live to the full just maybe not quite as stupidly as before.😵💫😵💫😵💫
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