Singapore trip, Methotrexate and health insurance

[Roltuba]

Morning all. We have now booked to stay with our daughter in Singapore over Christmas. It’s the first time we’ve been able to think of it for nearly 4 years because of PMR mobility and Glaucoma eye surgery issues. It’s exciting but we have some trepidation, partly because last time we went I came home in Jan 2015 with a nasty chest infection and the start of my PMR journey.

Singapore is very clean, organised and hygienic, but even so there are a lot of bugs there that our immune system is not used to – and the long flight is also a toxic environment! I am currently on 7.5mg Pred, reducing without trouble at the moment after being stuck on 10mg for nearly 2 years. I will reduce to 7mg before we go but will stop reducing while we are there and have plenty of Pred with me in case I have to increase.

I plan on stopping taking Methotrexate while I’m there to let my immune system have the best chance (like I did when I had ‘flu recently). Has anyone had advice on how long in advance of travel to stop the Meth? Or any advice at all on Pred during foreign travel? I will talk to the Meth specialist nurse if I can get hold of her, but don’t hold out much hope of useful information from anyone but you lot, going by past experience. My GP and Rheumy have more or less left me to sort myself out. Don’t know whether Meth has had any effect or whether PMR is receding but for the first time in nearly 4 years I feel almost normal on 7.5mg.

Insurance – happily that was easier than I thought. After shopping around we have gone with Leisure Guard. £196 for 2 of us aged 70, annual multi-trip worldwide. Seems to offer as much as we want. No cover for winter sports or cruising – the latter seems to be a very hazardous occupation! There is a list of pre-existing medical Waived Conditions which you only have to declare if you have something NOT on it. The list is very long and includes Hypothyroidism, shoulder injury, flu, glaucoma, cataracts etc. My wife hasn’t anything NOT on the list (had several that are on it) so doesn’t have to declare anything. Because I have PMR which is NOT on the list, I had a long ‘phone call telling them about everything like glaucoma (including surgery) ‘flu etc. etc. (There was £28 extra to pay because of my PMR.) They looked them all up and no further action/increase in premium was necessary for any of the Waived Conditions. But I have a record that I have told them in case of arguments. You do read about insurance companies that won’t pay out because you didn’t tell them about something seemingly irrelevant.

So, fingers crossed that nothing goes wrong before our Great Christmas Escape! Will have to be very careful not to overdo anything, but looking forward to trying a ‘bike for the first time in 4 years – it’s easy and flat in Singapore.

[SheffieldJane]

Is there any chance of stretching the budget to Business Class? Our loved ones live in Australia and this takes all the pain out of it and shockingly the air is better. Korean Air is the cheapest we’ve found. I was ill on one of their flights and they were so caring, I felt in very safe hands. I also took an extra dose of Pred because of the time difference which held me up very well.

[GOOD_GRIEF]

I'm not a medic, but since MTX takes some 3-6 months to reach theraputic levels, it would seem to me that stopping it wouldn't do much of anything to enhance the state of your immune system in a short term. It would seem to take at least that long for your immune system to come back.

Better to consult your travel bureau and get whatever immunizations or boosters are recommended, like typhoid, hepatitis A, hepatitis B, cholera, rabies, and influenza.

[PMRpro Ambassador in reply to GOOD_GRIEF]

Stopping mtx during an infection IS recommended as it does allow your immune system to work better on the illness. The 6 months I suspect is the time it takes to work on the disease process itself in RA or other inflammatory arthritides and that isn't the mechanism that is involved with pred.

[Mks9558]

Highly recommend flying business if you can. It is a very long flight and business class can make all the difference. I travel for business internationally and now that I have PMR-GCA I would not fly over 7 hours if not on business class. The stress and cramped conditions can be difficult when traveling. If not businesses class lots of articles with hints and tips to make sure you are comfortable.

Singapore is a lovely modern clean city with excellent healthcare. I was there in May before I got sick. I would not hesitate to visit especially with family living locally.

[DorsetLady PMRGCAuk volunteer]

Would agree with others -B class if you can possibly afford it. I’ve flown to NZ, once with GCA and once without (but arthritis both times) couldn’t have managed 2 long haul flights any other way. Appreciate if there’s two of you it’s a lot more! Went via Singapore, as you say beautiful city.

Just take extra medication in original boxes and copy of your prescription, all in hand luggage. Depending on timings of flights maybe a little extra Pred on the day, or night to help.

Check for boosters required, but you know the score.

Ask for assistance at airports - especially if via Heathrow- it’s a long walk!

I fly Singapore Airlines, not the cheapest, but definitely the best!

[Mks9558 in reply to DorsetLady]

Singapore air is the best without a doubt. Most importantly carry all medications in hand baggage DO NOT CHECK!

[Telian]

Sorry can't help with mtx but you seem to have covered everything else. I would add to the conversation that BC is worth every penny and can make such a difference between arriving less stressed, which can lead to this dreaded illness rearing it's head as it likes to - giving you the best chance of a lovely relaxing holiday. ATB.

[PMRpro Ambassador]

Unlike the others we have never flown BC because we couldn't justify the extra cost for the 2 of us and it isn't for our personal pleasure usually! I have survived cattle class flights with PMR to/from China, Singapore/Hongkong with Oz, Korea, Japan and the USA and Canada. More important to me has been airport assistance and that I regard as essential now. Splitting the flight to max.10 hour chunks and daytime flights help I find because you naturally move around.

This may be helpful

ncbi.nlm.nih.gov/pmc/articl...

Singapore was lovely - though I did get VERY nibbled in the botanical gardens...

[Valnvaughan]

My tip. During long flight wear a face mask! People will think you’re odd but who cares it filters that refiltered buggy air.

Long term re your travel insurance. We have just joined a paid for current account that benefits from annual travel insurance, amongst other benefits. There was an age (both over 70) loading plus long health interviews by phone, but our premiums for multiple health conditions was much less than your premium. And if you can keep a balance in current account, the interest balances the monthly fee. Worth investigating. We are in UK. Valerie

[Valnvaughan]

Just thought. Yes, get airport assistance. We have lived in Singapore for two 6 month stints. It is super clean.....no eating on transport etc. Loads to do if you do your research. Guided walks, if you can manage it, round the various ethnic areas enrich the experience. Night zoo is an experience unequalled!

Jealous. Valerie

[Roltuba in reply to Valnvaughan]

Daughter has lived there for 7 years and we have visited 3 times, but frustratingly not been able to for 4 years. Lovely place to visit, she has had to have some serious medical treatment which would have been considered over the top here (her insurance costs a fortune). She is an excellent guide, but we know how to get around quite well on our own too. She lives in Katong which has a lot of traditional architecture and is 5 mins by bike (if we can remember how!) from East Coast Park on the sea shore. Very hot and the most humid place on earth, hope we can still cope, need to be careful not to overdo it. Done Night Safari etc but Orchids at the Bot Gardens and Gardens By The Bay at night probably the favourites. Christmas decorations as over the top as they come 😅 And Ohh! the local food!

[Valnvaughan]

Me again. I had Shingles whilst living there. The medical service second to none! Even tried the Chinese doctor for acupuncture and revolting “ tea” which kept neuralgia at bay. Valerie