Been to Vancouver?
It used to be that a trip to Florida was a big deal, and a vacation in Europe a once in a lifetime occurrence. No longer. Now it seems that every week I hear of patients packing up and flying off to climb Kilimanjaro or trek to Machu Picchu. There has been a recent surge in people heading off to Thailand and Vietnam. All very exciting, but it seems few ever consider their medical condition before they book their exotic voyages. They're are often disappointed and even mad at me when I suggest that more first-worldly destinations might be preferable. Not long ago I had to convince a young woman who had just started on cyclophosphamide and high dose prednisone for a Wegener's vasculitis that Laos was not the optimal travel destination for her. Three days later she called back to say he was going after all because he was feeling much better on the prednisone.
There are many reasons for her and other rheumatological patients to be cautious in their globetrotting:
First of all, you are much more likely to get sick in a third world country. 30-50% of travelers to these places develop gastroenteritis and the risk is highest amongst the immunosuppressed . Even simple meds like proton pump inhibitors for reflux can increase the risk. There are also many other nasty bugs out there, all more likely to infect patients on immunosuppressors.
You can't get all the vaccinations necessary if you are taking biologics or other immunosuppressors. Yellow Fever, for example is a live vaccine and therefore contraindicated. Fortunately, many countries deny entry without these vaccinces, preventing immunosuppressed patients from even getting in.
Tuberculosis. As anybody who has taken a biologic knows, TB is a big concern and all patients are screened before treatment is started. If their PPD test is positive, we treat them before starting. This cures the infection that was there, but doesn't prevent a new infection from occurring, something that is a lot more likely to happen in a third world country.
If you do get sick, what kind of medical care is available. I have no idea what the situation is in the vacation regions of Thailand. It may be fine for all I know, but what I have noticed is that the traveling patients of mine don't know either.
Even if there is medical care available, who's going to pay. Some of my patients aren't aware that their insurance has specific clauses concerning prior illnesses. Here, most insurances won't cover your illness or complications if there has been any modification in therapy in the three months prior to departure.
So now I include travel recommendations with my normal biologic blurb. Florida sounds nice. France is lovely. Been to Vancouver?