Pumping Marvellous

Hmm those warm breezy days

Heart Failure Patients preparing for their holidays

It’s not as straight forward as it looks and it’s a good idea to get your carer involved with the preperation of your Holiday. Ok it’s not rocket science but in our opinion it is better to be prepared than not. Whether you are going on a domestic holiday or you are flying away somewhere you should do some research and always involve your carer.

Research tips -

Contact your clinician and check you are ok to fly and visit the country you want to go to. Check the airlines policy on you flying and if you have insurance check it is valid or whether you need a doctors note?
What’s the temperature?
What is the climate like? is it humid or is it a dry heat this can make a big difference
Medical facilities? what do they look like
Take into consideration what your carer thinks dont just be gung ho
Accomodation – make sure it is accessible for you eg steep walks and lot’s of stairs?
Make sure you are not too remote, it’s better to be close to facilities than a long walk
Assess the type of holiday, cruise, coach tour, beach, adventure etc etc this always creates a physical demand and if you know your capabilites then you will make the right choice for you and your carer.

Once you have assessed your ability for your holiday we would suggest you take the following notes into account and use it as a checklist -

• Get your Doctors note – Get your Doctor to include in that note all your current medication, include doses and generic names as well. This is very important as what your drugs are called in the UK maybe and probably are different from your destination. For example

An anti-arrythmic drug is called and prescribed in the UK as Dronadorone however it is not called this all over the world as it is marketed as Multaq“. Another example is the Beta Blocker which in the UK we know as Bisoporol but the genetic name is “Zebeta“. If you don’t understand then make sure your doctor notes it down on your prescription list.

The reason for the doctors note is that if you get admitted to hospital then they know exactly what you are taking. For example the delays many people had over Icelandic ash cloud.

Take double the amount of prescribed drugs you need so if you are going for 1 week take 2 weeks worth of supplies – don’t forget any supplements you take as well, treat them in the same way. An example of this is the delays many people had over Icelandic ash cloud.

Use tablet holders to reduce the space whilst you are packing. Take empty flat pack pill boxes becuase of easy identification

If you take warfarin then take your yellow book with the recorded INR levels – this is an international standard and will be understood.

If you are on diuretics you may find that you get very thirsty if you are going to a destination that is hot it is important to keep yourself hydrated however you need to be careful you don’t drink too much fluid, remember alcholic drinks will dry out in even further. Take an atomiser, fill it with water and when you feel thirsty spray your mouth.

Make sure you take the appropriate sun tan lotion with an effective SPF value, I take a minimum of an SPF 30 lotion.

Take a first aid kit and in that kit take your usual pain killers, most Heart Failure patients cannot take anything other than a parcetamol/co-codamol based pain / fever reliever. Very very important don’t rely on local facilities at your destination. Be prepared and prepare well.

These are just snippets of information so keep watching pumping marvellous over the next 10 days as we will be posting lots of useful information

Flying with Heart Failure

It’s the holiday season and before we go on talking through this frequently asked question the information in this post is purely opinion and you must always discuss with your clinician. In fact the stipulation of many travel insurance companies means that you must be certified to fly usually by a consultant. Irrespective whether you need certification we would recommend you speak to your consultant. In our opinion we feel it is crucial. Anyway here goes -

Over one billion people travel by air each year.The information in this post refers to considerations regarding fitness to fly as a passenger. This is not about assessing your ability to fly but it includes the measures which are taken into consideration when assessing your ability to fly.

The information given is general and not exhaustive; individual patients may need to have several conditions taken into account and different airlines have varied policies. The sources of advice used are only guidelines and clinical judgement should always be used in their interpretation.

Some airlines require medical certificates confirming that a patient is currently stable and fit to fly. Most have medical advisors who provide advice and ‘clear’ passengers as fit to fly. They may ask for a medical information form (MEDIF). The British Medical Association (BMA) advises doctors ‘to word statements on a person’s fitness to fly carefully, indicating the information on which the advice is based, rather than positively certifying a person’s fitness’. For example:

• ‘I know of no obvious reason why this person should not fly’; OR
• ‘There is nothing in the medical record to indicate that flying is risky for this patient’.

This ensures that the doctor is not guaranteeing in any way that this patient can travel without any problem but rather saying that, on the available evidence, there is nothing to indicate a greater risk for this person than for others. However, the doctor is partly dependent on what the patient chooses to disclose to them about past health problems.

The main factors to take into account are whether air travel could adversely affect a pre-existing medical condition and whether or not a patient’s condition could adversely affect the comfort and safety of the other passengers, or the operation of the flight. Regardless of a doctor’s opinion on this latter question, the ultimate sanction to refuse travel lies with the airline and captain of the flight. If they consider there is a risk to the aircraft or its passengers, they may refuse to carry a particular passenger.

Modern aircraft are not pressurised to sea level. Cabin altitude equivalent is usually between 5,000 and 8,000 feet which means that there is a reduction in barometric pressure and a reduction in the partial pressure of alveolar oxygen. Sometimes during flight, although not usually for long periods, oxygen saturation levels can fall to around 90%. A healthy individual can usually tolerate this with no problems but it may not be the same for someone with Heart Failure.

Basic considerations when assessing a patient’s fitness-to-fly include:

• The effect of mild hypoxia (deprivation of oxygen) and decreased air pressure in the cabin.
• The effect of immobility.
• The ability to adopt the brace position in emergency landing.
• The timing of regular medication for long-haul/transmeridian travel.
• The ability of the patient to cope mentally and physically with travel to and through the airport to reach the flight and on disembarkation.
• Will the patient’s medical condition adversely affect the comfort or safety of the other passengers and the operation of the aircraft?
• What health insurance cover does the patient have in case of problems?

Cardiovascular contra-indications to commercial airline flight include:

• Unstable angina.
• Decompensated congestive cardiac failure.
• Uncontrolled hypertension.
• Coronary artery bypass graft within 10 days.
• Uncontrolled cardiac arrhythmia.
• Severe symptomatic valvular heart disease.
• Uncomplicated percutaneous coronary interventions (e.g. angioplasty with stent placement) within 5 days – individual assessment is needed after that to ensure fitness and stability.

The decrease in oxygen saturated during air travel may affect those with cardiovascular disease. Indications for in-flight oxygen in cardiovascular disease include:

• Need for oxygen at baseline altitude.
• Heart failure – New York Heart Association’s (NYHA) Class III-IV
• Angina Canadian Cardiovascular Society (CCS) Class III-IV.
• Cyanotic congenital heart disease.
• Primary pulmonary hypertension.
• Other cardiovascular diseases associated with known baseline hypoxia (deprivation of oxygen)

It is unusual for patients to be allowed to take their own oxygen supply and oxygen is usually arranged by the airline who must be aware in advance. A fee is usually charged. This may change in the future and there are ongoing discussions regarding this.

Patients with pacemakers and implantable cardioverter defibrillators can fly once medically stable

Flying, Travel and Heart Failure

After just being on a Transatlantic flight just over a month ago I thought this little article was quite reassuring for Heart Failure patients. As always consult with your Doctor / Consultant before flying anywhere. It will probably be a stipulation of your medical insurance to get an “ok” from them anyway.

Although this article is focussed on cardiovascular you can relate it to Heart Failure. Look for the highlighted text.

This article is by sify

Most people with cardiovascular diseases who are not critically ill can safely fly, a news report says.

The study, conducted by the British Cardiovascular Society, says that such people can undertake air travel provided they drink plenty of fluids, wear compression stockings and take a blood thinner.

However, the fluid intake should exclude alcohol, tea and coffee.

Consultant cardiologist David Smith of National Health Service (NHS) Foundation and colleagues explain that the main impact of air travel is the inhalation of air with reduced oxygen content in a pressurized environment.

This results in lower circulating oxygen levels in the blood, known as hypobaric hypoxia, says a society release.

Passengers already at high risk of angina, heart failure or abnormal heart rhythms might be adversely affected by hypoxia.

Otherwise, the blood oxygen levels induced by flying appear to have little or no adverse circulatory effects, certainly not for short-and medium-haul flights, for heart patients, the report says.

So what we are saying is that you must take the advice of your Consultant or Doctor. Don’t book until you have had the OK!