Vacationing With Multiple Sclerosis
Your guide to planning a safe and healthy trip with multiple sclerosis
Reviewed By Brunilda Nazario
Chris Lombardi is not your ordinary traveler. The 42-year-old writer and educator has multiple sclerosis (MS). But the threat of a disease flare-up didn't keep Lombardi from a recent whirlwind tour of Asia. And according to travel and medical experts, it needn't stop others with MS -- and an itch to travel -- from vacationing either.
Planning Ahead: Medical Considerations
If you're like most people with MS, you rely on medication to reduce the frequency and severity of attacks. But traveling with your medication can be tricky, especially if you take one of the commonly used injectable therapies that require refrigeration.
"Determining, in advance, how you're going to transport your medications is essential," says Robert Fox, medical director of The Cleveland Clinic's Mellon Center for MS.
For starters, know whether your medication can be stored at room temperature and for how long. Some medications that generally require refrigeration can temporarily be stored at room temperature. For instance, Copaxone can remain at room temperature for one week, but it is light-sensitive, so remember to protect it from light when storing it. Rebif can be stored at room temperature for up to 30 days as long as it is not directly exposed to light or heat.
In some instances, flexibility of a medication's formulary can save hassles. Such is the case with Avonex. This medication is available in prefilled syringes, but they can be stored at room temperature for only 12 hours. However, Avonex also comes in a powder, which requires no refrigeration, but it requires reconstitution with sterile water prior to injection. Fox suggests that patients who take Avonex and plan to vacation somewhere that may lack refrigeration ask their doctors for a prescription for the powdered formulation.
If you're planning on flying, the airlines will require you to justify why you're carrying syringes. To this end, Fox suggests having an official labeling of injection medication with you. He also recommends carrying the medication in the original pharmaceutical manufacturer packaging. And although airlines don't require flyers to have the original prescription from your doctor, Fox says, "It can't hurt."
Climate, always a factor for vacationers, takes on even greater significance if you have MS. Heat can exacerbate many of the symptoms of MS. But there's good news on this front.
"We don't think climates can bring on relapses or induce inflammation. For some, a hot environment can bring out underlying, or latent, symptoms. But it's a common misconception that patients with MS can't get hot," Fox tells WebMD.
Rather than avoiding certain climates altogether, Fox advises vacationers with MS to play it smart. Dress appropriately -- wear wide-brim hats and loose-fitting clothing to help keep you cool. Also consider wearing cooling garments like those used by athletes. And find out beforehand if your destinations contain air-conditioned accommodations.
Although the majority of people with MS do not become severely disabled, the Americans With Disabilities Act has allowed accessible travel to become a reality for people with limited mobility.
"Every mode of transportation has become more accessible in the last decade," says Candy Harrington, editor of Emerging Horizons, a magazine for accessible travel. Airports are a prime example -- look around and see how many wheelchairs there are.
"Super Shuttle now offers accessible airport transfers in many cities, and accessible taxicabs are available in many cities. And if you'd rather drive yourself, there are many companies that rent accessible self-drive vans," says Harrington.
Although access-friendly accommodations such as those required by the ADA do not apply to ships, cruises are nonetheless becoming an increasingly popular choice for vacationers with limited mobility. "Twelve percent of people with disabilities have taken a cruise, as opposed to 8% of the general population," Jani Nadir, spokesperson with the Society for Accessible Travel and Hospitality, tells WebMD.
"Most ships have cabins adapted for accessibility. Even cabins within the least expensive category typically have a few accessible rooms," Nadir says. If you want to take advantage of these special accommodations, book early, and find out just exactly what the cruise line means by "accessible" cabins.
Perhaps you have chosen to fly to your destination. If so, you're probably wondering how you're going to manage if you have to check your wheelchair, walker, or cane as part of your baggage at the airport. No need to worry. Thanks to the ADA, any such device that your disability necessitates is not considered baggage, so you don't have to check it or pay extra for it, explains Nadir.
While legislation like the ADA has made traveling easier for people with limited mobility, Nadir warns vacationers with special needs not to take accessibility for granted. "Never assume anything," she advises. Instead, she suggests getting the information you need firsthand. "Call the hotel yourself. Ask detailed, open-ended questions."
Preventing and Managing Medical Problems While Away
If you're like most vacationers, you want to see and do it all. But if you have MS, cramming your itinerary with nonstop activity is certain to backfire. "You've got to build in days for resting," says veteran traveler Lombardi. She recalls, midway through her tour of Asia, having to spend a day in Cambodia lying under mosquito netting, exhausted. Fatigue is common and worsens as the day progresses, but MS-related fatigue is more severe.
Lombardi learned to turn down opportunities during her trip that she knew would leave her vulnerable to MS-related flare-ups. In addition to building in down time, Lombardi spent an hour each morning doing gentle stretches and exercises to maintain joint flexibility.
Sometimes, despite your best efforts, medical problems do arise while vacationing.
For instance, many people with MS are prone to bladder infections. In addition to provoking discomfort, the sudden onset of such an infection seems to activate relapses, according to Fox.
"You don't want to be stuck in Fiji without an antibiotic. Most doctors are willing to give patients with recurrent infections a prescription for when they travel," Fox tells WebMD. So if you're susceptible, ask your doctor for a prescription before your vacation.
Then there's the MS vacationer's worst nightmare: a relapse. Standard treatment of a relapse is a course of steroids, usually given at a hospital. "That could be a challenge when you're traveling, but steroids should be freely available at a local hospital," Fox says. If the symptoms are mild and not that disruptive, Fox suggests that vacationers can probably wait until they get home to seek medical attention.
Dramatic improvements in accessibility make it easier for people with MS to enjoy a variety of vacation options. So do changing perceptions among the medical community. Whereas doctors used to tell their MS patients to steer clear of exertion, that's no longer the case.
"It turns out the exercise is good for patients. It increases their sense of well-being and probably optimizes their functioning more so than sitting around not doing much," Fox tells WebMD.
So if you have MS, body surfing or skiing from dawn to dusk may not be part of your vacation's itinerary. But you probably can do these activities in moderation. The key is to know your body's limits and pay attention to the cues it gives you.
"There's nothing you can't do with MS, as long as you can do it," Fox says.
Published June 14, 2004.