Pain-Free Living

Traveling With Arthritis

by Kurt Ullman, RN

Traveling when you have arthritis can present challenges. Getting medicine through security at the airport, making sure that hotel rooms have bathrooms with handrails, and getting to and from sightseeing attractions all involve some extra planning.

But now there are more resources than ever before to help people with osteoarthritis (OA), rheumatoid arthritis (RA), and other forms of arthritis travel — from Web sites listing accessible accommodations to travel agents who specialize in planning trips for people with limited mobility. So whether you’re heading just over the state line or halfway around the world, read on to find out how to plan the best trip possible for your abilities.

Where to go

When you’re deciding where to go on a vacation, consider the environment and climate of the places you are thinking about. If you hurt more on cold and wet days, you may not want to travel to some states or countries in the winter. If, on the other hand, you don’t do well in heat and humidity, then going to the Deep South or tropical destinations like the Caribbean during the summer may not be a good idea.

Think about the distance to your destination, too. How will the length of your trip affect your energy level once you get there? You may want to plan to use the first day at your vacation spot to rest up so you can fully enjoy sightseeing and other activities on subsequent days.

Getting around

Once you get where you’re going, another concern is getting around. Before you leave, look into the availability of accessible taxis, buses, subways, or other ways to get where you want to go during your stay. A good way to find out about transport and address other concerns is to talk to the local convention and visitors bureau. Another tip is to contact an independent living center at your destination. These private, nonprofit agencies are run by community members with disabilities who are usually knowledgeable about navigating their towns.

Even if you’re visiting a big city with lots of amenities, that doesn’t necessarily mean that you’ll have an easier time getting around than you would in a smaller, less developed place. “New York City has around 13,000 taxis, but only 372 are accessible” to people in wheelchairs, says Jani Nayar, Executive Coordinator for the Society for Accessible Travel and Hospitality in New York. “On the other side, it is not all that hard to rent a van to roam around Aruba.”

Where to stay

The top three considerations when looking at your lodging options are location, location, and location. If you’re planning to stay at an all-inclusive resort or big theme park, think about how easy it is to get to — for example, is it within a convenient distance of the airport or train station where you’ll be arriving? If you’ll be sightseeing, you’ll want your accommodations to be close to the places you would like to visit.

Also, take into consideration any problems specific to your situation. If you’re unable to climb stairs, the quaint bed and breakfast with rooms on the second floor may not be your best bet.

When you’re researching places to stay during your getaway, hotel Web sites are good places to start. Most give general information on a hotel’s amenities; for example, whether there is a restaurant on site so you don’t always have to leave to get food. Many also have information on how far it is to points of interest in the area.

Once you’ve narrowed down your list of possible places to stay, call the hotels directly to ask specific questions about the rooms. Also, you may want to ask to talk to staff beyond the front desk. Ms. Nayar was traveling with a friend in a wheelchair. At the hotel front desk, she asked if they had been given an accessible room. Both the person at the desk and the manager denied that there were specific rooms with the equipment her friend needed.

“I then asked to talk to a housekeeper,” she says. “When I asked her if there were rooms where you could roll a wheelchair into the shower, she said there were four. I always ask to talk to housekeeping or the engineering department, as these are the people who actually go into the rooms.”

Which attractions?

You should also talk to people directly at the attractions, museums, or other tourist sites you plan to visit to find out about accessibility issues. The information you find on the attractions’ Web sites may not be enough, since “accessible” doesn’t always mean the same thing to different people. For example, the Web site of a particular attraction may note that only the parking lot is “accessible.” In reality, the entire attraction may be very easy to get around, and a person relying on the Web site alone may miss out on the experience.

Travel agents

Although it’s possible to get all the information you need to plan a trip on your own, Ms. Nayar suggests that travelers consider using a travel agent who specializes in the needs of people with arthritis or mobility limitations. “These are people who have gone past basic travel education and are attuned to the special needs of people with arthritis,” she explains. “They have researched places to go, things to do, and ways to get there with an eye toward things others may not think about. You are less likely to get a nasty surprise when they plan your trip.”
If you do decide to use a travel agent, ask up front what kind of fees, if any, you can expect to pay for their services. Some companies, such as cruise lines and hotels, pay travel agents a commission on packages they sell, so no extra cost gets passed on to travelers. On the other hand, most airlines no longer pay commissions, which means that agents may charge travelers a small fee to book their flights.

Finding an agent with the necessary expertise requires some work on your part. Donna Thomas, Certified Travel Counselor and president of New Zealand Travel, Inc., in Langhorne, Pennsylvania, is a travel agent with arthritis. She suggests that you use the following guidelines for finding an agent to work with:

• Talk to other people you know with arthritis about whom they have used and would recommend.
• Contact assisted living centers in your area — they often work with travel agents when scheduling trips for their residents.
• Visit Web sites that list travel agents who have experience working with people with arthritis. Many sites have forums or chat rooms where you can ask questions and get information. (See Travel Resources for some suggested Web sites.)

 

• Check with your local Arthritis Foundation chapter (visit www.arthritis.org and enter your zip code under “My Community”) to ask if it recommends particular travel agents to people who plan travel to Arthritis Foundation conferences.

 

Once you choose a travel agent, it’s time to get down to the business of planning your trip. The agent will usually begin by asking you about your interests, where you want to go, and what you want to do while on vacation. Next, the agent will ask you about your limitations so he or she can determine how to work around them. The agent will want to know things like how long you can stand, how far you can walk, and if you need time in the morning to “work out the kinks.” Ms. Thomas notes that it is very important that you are completely honest with your travel agent about what you can and can’t do. In other words, don’t exaggerate your abilities. The agent should know about any health or other concerns that you or your traveling companions have.

When you’re looking into tours and sightseeing opportunities, there are some things you should find out before deciding which ones are right for you:

• Understand the pace of the tour and if it is time-limited, which may mean that you can’t take breaks if you need to.
• If you’re taking a bus tour, find out if the bus is full size, a trolley, or a minivan, and if there will be a guide to help you off and on.
• Find out if the bus or van will let you off close to the front entrance of the attraction or if you will have to walk from a parking lot.

Getting to your destination

It used to be a slogan of a cruise line that “getting there is half the fun.” That isn’t necessarily the case anymore, but with a little advance planning, you should be able to travel to your vacation destination in relative comfort. Here’s a guide to making different mode of transport more comfortable.

Planes. If you’re flying, try to book a nonstop or direct flight so you don’t have leave the plane and get to another gate. Arrive extra early so you have time to talk to the airline employees about your needs, asking them to make arrangements, if necessary, at your final destination or at the intermediate airport if you do have to change planes. (For tips on getting yourself and your medicines through airport security checkpoints, see Getting Through Airport Security)

Make use of available shuttles or transport carts, or ask for a wheelchair. The airlines provide these amenities to help people move around the airport. Remember that it is customary to tip porters and other airport employees who assist you.

Before calling for general boarding, gate attendants often allow those who need extra time or help get onto the airplane first. Take advantage of this “preboarding” period — it lets you get settled into your seat before the rush of people boarding the plane. Try to get an aisle or bulkhead seat, because these have more legroom. However, make sure you are not seated in an emergency exit row if you are unable to help other passengers in an emergency.

Trains. For people with arthritis, traveling by train may be easier than traveling by plane. Amtrak has a special services desk that can reserve accessible seats, wheelchair space, or overnight accommodation in an accessible room. (Note that these reservations can be made by phone or TTY or at an Amtrak ticket counter, but only some reservations related to accessibility can be made on the Amtrak Web site.) If you take a medicine that needs to be kept cool, Amtrak can provide ice for your cooler or container.

The downside to train travel is that most passenger trains require you to climb stairs to enter the car, so make sure you have help to board and disembark. Amtrak can provide a wheelchair ramp or bridge if one is needed. For more information about traveling on Amtrak with special needs, call (800) USA-RAIL (872-7245) or visit www.amtrak.com and, under the “Plan” tab, click on Accessible Travel Services.

Buses. Interstate buses can pose special problems for people with arthritis. Most don’t have lifts and don’t “kneel” to make entry easier. However, if you need a traveling companion to assist you, you can often get a fare reduction or waiver for the second person. Some companies require you to have a doctor’s letter to get the discount, while others don’t, so make sure you know what documentation you need before you purchase tickets. Most bus companies request that you call them at least 48 hours before your departure if you will need special assistance during your trip.

Cruises. Especially for novice travelers, cruise ships can be a great option. You can see many different places without packing and unpacking at each one, and cruise ship staff tend to be attuned to the needs of people with disabilities. Although you can book your own excursions at port stops, cruise lines have many of their own available and usually give a good description of what to expect on an outing and how physically challenging it will be.

“The major cruise lines have built their ships with accessibility in mind,” says Ms. Thomas. “They have contacts at the embarkation port to arrange for things like scooters. Whatever you need will be waiting for you when you arrive, and you leave it behind at the end of the cruise.”
When booking a cruise, make sure to find out at which ports of call your ship will be docked and which one you will need to be “tendered.” The former means that when you leave the ship, you go directly to the pier. If you are tendered, you will have to get into and out of smaller boats that will take you to the port. While the crews are trained and adept at transfers to and from the tenders, getting to shore can take longer and is dependent on weather and sea conditions.

Travel insurance

Travel insurance is an especially important part of making travel plans for someone with arthritis. There are two types, and both need to be addressed early. Travel agents can often help travelers work their way through the process of choosing policies, which can be confusing.
Trip interruption insurance protects you against breaks in your plans. Most policies of this sort reimburse you for losses if you need to cancel your trip for any covered reason. They accept claims related to out-of-pocket expenditures for flight or other transportation costs should you have to come home early for illness or personal reasons. In addition, they also help defray expenses for unforeseen bumps, such as hotel accommodations and food if your flight gets cancelled. However, some of these policies won’t cover illness or injury related to pre-existing conditions (like arthritis), so make sure you read the details carefully before signing up.

The other insurance that you should consider if you’re traveling overseas is health insurance for international travelers. Many insurance plans, including Medicare, will not pay medical expenses incurred outside the United States and its territories. Travel medical policies pay for these expenses and can often refer you to a local English-speaking doctor.

When you are considering a travel medical plan, make sure that evacuation insurance is included. Few private health-care policies, and none of the government programs, pay to get you back home via air ambulance or another conveyance. Just getting back home within the United States can cost $15,000 or more, and the costs to repatriate someone from overseas will be much higher.

Travel insurance is available through many different paths. Your current insurance agent may be able to sell you a policy. Many travel agents offer insurance, as do most tour operators. Some Web sites, such as www.insuremytrip.com, allow you to compare insurance plans from different insurers. It is often cheaper to get a package plan that includes both trip-interruption and international medical coverage. This can also streamline the process should you need to make a claim because you would only need to talk to one claims office.

“Make sure you understand what you are getting and the company’s policies on pre-existing conditions,” says Ms. Thomas. “In this case, a pre-existing condition doesn’t necessarily mean you won’t get insurance, just that you may have to meet certain restrictions. Some policies only cover if you pay within a certain time after making your initial deposit. Others say you are eligible if you get the policy before final payment.”

Packing for your trip

Now that the figurative heavy lifting of planning is done, the literal heavy lifting of packing comes next. You may want to consider bringing the following items on your trip:

• Travel-sized heat and cold packs for pain relief
• Assistive devices, such as a tool to button your shirt, even if you use them infrequently
• A horseshoe pillow to support your neck if you fall asleep in your seat
• A nightlight or flashlight and batteries so you don’t become disoriented at night
• A list of medicines you take and, if possible, a prescription form (including a list of any allergies you have)
• A brief medical history in list form that includes contact information for your family doctor and any specialists you are seeing

Under no circumstances should you pack in your checked luggage any prescription or over-the-counter drugs you might need during your travels. You’ll want to have them handy if you need them and you certainly don’t want to run the risk that your medicines won’t be available if your bags get lost.

Time zones and
your medicines

When you travel to another time zone, timing doses of any drugs you take can be a concern. How you handle it may depend on how far you go and when you will be back. For example, if you’re going from New York to San Francisco for a week, you can probably stay on your home schedule. But when a trip takes you to Europe or Asia for a month, you may have to work with your doctor to adjust your drug schedule to your new time zone.

“Unlike some drugs where timing is crucial, taking arthritis medications is more variable,” says Susan Goodman, MD, Assistant Attending Rheumatologist and Internist at the Hospital for Special Surgery in New York City. “In consultation with your doctor, you can spread out the dose or increase the interval to transition to local time. You should also make sure you understand any instructions from your physicians on taking medications during travel days.”

One strategy for dealing with time zone changes is to wear two watches, with one set on the time at home and the other on the time at your destination. This will help keep you oriented while you get onto a new schedule at your new location.

Protecting yourself
from infection abroad

Travel to certain destinations, especially those outside the United States, can carry an increased risk of certain infections. People who have an autoimmune form of arthritis, such as rheumatoid arthritis, psoriatic arthritis, or lupus, and take drugs that suppress their immune systems may be especially vulnerable to infection. But everyone should take precautions. Talk to your doctor about any vaccinations you should consider taking, and make sure to plan your vaccination schedule well in advance of your trip, since some vaccines consist of a series of multiple injections. Information about diseases that are common in different areas of the world and vaccines that you may need is available through a special section of the Centers for Disease Control and Prevention (CDC) Web site.

Ready, set, go!

Having arthritis may mean taking your trip at a slower pace, but it shouldn’t stop you from traveling where you want to go. “Most people living with chronic diseases have a firm idea of what they can, and perhaps more importantly, what they cannot do,” says Dr. Goodman. “They are generally able to match up what they want to do with what they can do and have a great time.”

Traveling with arthritis may take some extra planning, but with any luck, a comfortable, fulfilling trip will be your reward.

Last Reviewed January 24, 2013

Kurt Ullman has been a medical writer for more than 25 years. He is based in Indiana.

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