Travel to Malaysia-Sydney-Perth-Mauritius-Home. Time differences and Prednisolone dose. Advice please.

[Positive__]

Hi,

I have read Dorset Lady's excellent post about when she flew to NZ via Singapore but would like specific advice on my trip please.

We are travelling to Australia in just under 3 weeks. So I normally take my 13mg Prednisolone with breakfast between 7am and 9am (depending on what time I wake up). So I've assumed taking the dose at 9am local time. So I think no extra will be needed on the way out if I do that but the way back is a bit trickier. So I'm not sure if when the days are only 3 or 4 hours longer than 24 hours if it's best to take a bit extra the morning I fly to last the longer period or to take a small top up dose part way through? What do you think? I've put the departure and arrival times in local time in case that's relevant. I welcome your help on this. Lots of flights:

- 11.00 London (GMT+1 daylight saving) to 07.15 Malaysia (GMT+8: so 7 hours ahead/lost). So I'm thinking taking my Pred at 9am local time after arrival will be fine (will be only 17 hours after my UK morning dose).

- 09.10 Malaysia (GMT+8) to 20.35 Sydney (GMT+11: so 3 hours ahead/lost). So I'm thinking taking normal Pred dose at Sydney time the next day should be OK (will only be 21 hours since my Malaysia morning dose).

- 13.35 Melbourne (GMT+11) to 14.30 Perth (GMT+8: so 3 hours behind/gained). So should I take slightly more (and if so how much) in Melbourne morning dose to last the 27 hours til the Perth 9am dose?

13.05 Perth (GMT+8) to 17.10 Mauritius (GMT+4: so 4 hours behind/gained). So should I take slightly more in Perth morning dose to last the 28 hours til the Mauritius 9am dose?

22.25 Mauritius (GMT+4) to 06.55 London (GMT+0: so 4 hours behind/gained). So again should I take more in Mauritius dose to last 28 hours.

No flights on Saturdays which is my Alendronic Acid day so no problems there.

Plus any other things I should be thinking about? So far I have:

Laminated the NHS Steroid User/Adrenal Crisis card and the one from the chemist with list of my doses and dates when changed. Bought a silicone Medical Alert wristband. Got loads more medication than I need to take with me (in case of flares) and plan to always have it in hand luggage (in original boxes with Pharmacy labels on) on all flights. Also I will take the Repeat prescription list which comes with each prescription. We don't ever see a prescription anymore. I can also take a print of the screen print of the NHS app listing my prescriptions. Ensured my next of kin details are up to date and that my sister (nok) knows about Adrenal Crisis. I'm travelling with hubby.

Plus I am taking a paper and electronic copy of both the sick day rules and the Flare Protocol.

Really looking forward to the trip and just wanting to have sensible plans. I always think if you plan for unforseen issues they never occur but if they do I'll know what to do.

Many thanks to all of you for being so helpful and generous with all your expert knowledge.

[PMRpro Ambassador]

On the long days direction of travel, I took a proportion of the daily dose after 24 hours to cover the extra few hours. So I took the normal dose in the morning, 24 hours later I took 3/24 or 1/8 of the daily dose extra and then the full dose again 3 hours later. Or it would be 4/24, 1/6, depending on the time difference.

The problem with taking a bigger dose in the morning is that that may not last the 27 or 28 hours to the next full daily dose. The antiinflammatory effect lasts 12-36 hours so it may start to wear off by 24 hours.

Looking at that just makes me feel tired!!! How many days are there between each pair of flights?

[Positive__ in reply to PMRpro]

Hi PMRpro,

Thank You for your reply.

I see what you mean - take my normal 13mg morning dose then 24 hours later on the longer days take a top up of 2mg? Then take the normal 13mg at the next 9am local time?

Although I've just realised that will be 5am or 6am local time 😱. Do you think the same result would be achieved by taking the top up 2mg with my evening meal on that long day? So 13mg 9am ish, 2mg 6/7pm ish. Then 9am the next day 13mg.

It's not as arduous as it looks (though it was booked before my diagnosis). The whole trip is about 6 weeks in total. 6 full days in Malaysia, 9 in Sydney, short flight to Melbourne (but no time difference) and stay there 6 days, 13 in Perth, 6 days in Mauritius.

We've got relatives in Sydney and Melbourne and so there be sitting around chatting (no sight seeing - since we've done all that before).

Thank you for your help. 😀

[PMRpro Ambassador in reply to Positive__]

Oh yes, that sounds doable with breaks like that. You will find it all makes more sense as you are actually doing it and DorsetLady who has also written posts about it having done it will say it in a different way and that always clarifies things. I've not done the West End of Oz, would love to but I doubt it now.

[DorsetLady PMRGCAuk volunteer]

Was this the post you read or an earlier one?.

healthunlocked.com/pmrgcauk...

To me is feels as if you are over complicating things by looking at each new destination in comparison to GMT timings… but then I am a simple soul…

I forgot timings of departure country once on the plane and put my brain on times at destination.. and then worked out if I need to add in a couple of mgs on the actual flight, assuming I was going to take my main dose at 8am local time.

I know you have more stops/flights, but you seem to be at each place for a week at least so you should be able to slot into a pattern at each destination.

I think you have to do what you feel happiest with…

[Positive__ in reply to DorsetLady]

Thank You DoresetLady,

Yes I was looking at the latest post (that was the one in the FAQs). I am greatly inspired that you managed that long trip and on your own. I feel it's quite daunting so that's probably why I am overthinking it a bit - I am keen to know what I'm doing.

Thanks to you and PMRPro I am now feeling happy on how to manage the Prednisolone. I know it sounds silly but normally my husband and I talk decisions through but I feel he doesn't really know anything about PMR (and really I don't want him to need to know all the detail). Hence why I love having all you experts to rely on. He's organised the whole trip - I'm organising my meds! 🤣

[DorsetLady PMRGCAuk volunteer in reply to Positive__]

He's organised the whole trip - I'm organising my meds

That sounds fair enough to me.. now you have head around it-settle back and look forward to it -and enjoy… 😊

[Positive__ in reply to DorsetLady]

Thank you. 🪷

[PMRpro Ambassador in reply to Positive__]

Fair division of labour there!!!

[Positive__ in reply to PMRpro]

Absolutely! 🤣

[AgedCrone]

Have two watches & leave one on UK time…..saves all the angst of working things out en route.

[Positive__ in reply to AgedCrone]

Good idea AgedCrone. I've got an app on my phone which shows the current time in each of the countries I'm interested in. Very useful for keeping in touch with our grown up children at home.