Travel tips from Dr Handford: Flying after a stroke
If you have suffered a stroke, either recently or in the past, there are some things to consider when organising your next holiday. If you plan to fly, it is worth thinking about the following issues ahead of time, to make your journey go smoothly and safely.
What is a stroke?
A stroke describes a condition which leads to a loss of oxygen supply to part of the brain. This impairs the function of the part of the brain affected.
Most strokes (about 85%) are due to a blood clot blocking an artery supplying a part of the brain. Some strokes are caused by a bleeding into an area of the brain, which then becomes damaged as a result.
The kinds of symptoms experienced by people who have a stroke is hugely variable, depending on which part of the brain is affected, and for how long the blood supply is reduced.
What does it mean if I have had a ‘mini-stroke’?
You may have been told that you suffered a ‘mini-stroke’, or a ‘TIA’ (Transient Ischaemic Attack). The key here is that the impairment, and therefore the symptoms, are transient. They disappear completely, usually very rapidly, but certainly within 24 hours. A TIA is a warning. It shows that you are at risk of a stroke, and gives your doctor an opportunity to work with you to reduce or eliminate that risk, thereby preventing a stroke in the future.
A stroke, by definition, leaves some impairment or symptoms that last longer than 24 hours. The symptoms (for example weakness, facial drooping, or slurred speech) may still resolve completely, but if it takes longer than 24 hours, you have had a stroke.
Can I still fly?
Yes! You can. There is no formal medical guidance on how long after a TIA or a stroke you should wait before doing so, so do ensure you check with your airline prior to booking.
Most carriers advise NOT to fly until 10 days after a TIA, or 21 days after a stroke. Some airlines recommend waiting until 3 months after a stroke, if it has left you with some residual symptoms.
If you have had the type of stroke which is caused by bleeding into the brain (a haemorrhagic stroke), the usual advice is to wait 6 weeks until you fly.
If you need to fly urgently between 10-21 days after a stroke, for example to get home from holiday to get medical care, your airline is likely to require you to have a formal medical assessment and certificate prior to flying.
What are the concerns about flying after a stroke?
Oxygen:
There are several potential risks associated with flying which may be more serious if you have had a TIA or a stroke.
The air pressure inside the aeroplane is much lower than the atmosphere we breathe on the ground. This means that there is less oxygen carried in your bloodstream. Because strokes are a result of reduced oxygen to the brain, it makes sense that this increases the risk of stroke or TIA.
The general advice is that if you can walk 50 metres without getting breathless, or climb one flight of stairs without getting breathless, you will be able to tolerate the lower oxygen level on a flight.
If you are unsure, or have co-existing lung disease, please make sure you discuss this with your GP before planning a flight.
Immobility:
Depending on your destination, you may be seated for a long period of time. This predisposes to clots forming in the leg veins, called a DVT. If you are left with mobility difficulties as a result of your stroke, you may be at even higher risk of developing a DVT.
Make sure you book extra legroom for your flight, walk around or move your feet and legs as often as you can during the flight, and keep well hydrated on the plane. Avoid alcohol which causes dehydration and puts you at higher risk of clot formation.
The best way to prevent a DVT is to walk around. If you cannot do this regularly, try to at least move your lower legs every 20 to 30 minutes whilst seated. Even small movements like rotating your ankles and raising your heels off the floor repeatedly is valuable.
Further stroke:
Irrespective of flying, there is a 20% risk of having another stroke in the first month after having a stroke. This is one of the reasons airlines are reluctant to encourage air travel within the first weeks after a stroke.
After a TIA or stroke you are likely to have multiple GP as well as hospital appointments to attend. You may also need regular physiotherapy, speech therapy, or dietician support. The need for close blood pressure monitoring and intensive rehabilitation EARLY after a stroke is vital for improving the chances of a complete recovery. You may choose to have a holiday after this initial period is over in order not to miss this essential follow up.
Co-existing medical problems:
Make sure you consider other medical problems which may affect your health on board a plane. Sometimes people are diagnosed with several new conditions at the time of their stroke – such as diabetes, atrial fibrillation, high blood pressure, or anaemia. There may be new medications to get used to and to stabilise. It is a good idea to make sure your GP is happy for you to take a holiday in the midst of all this prior to booking.
I’ve booked a flight! What can I do to help it go well?
Be kind to yourself – try to book your flights for times that will minimise stress and tiredness. Trying to get to the airport through rush hour, or having to get up at 3am, is enough to put anyone’s blood pressure up! If you can make things more pleasant – do it. Consider staying at the airport the night before in a hotel, booking flight times that fit in with your routine, and taking a taxi to the airport instead of driving.
Book extra legroom seats in advance. This will make for a more pleasant flight, less stress when boarding, and allow you to move around more during the flight.
You may also be able to check-in in advance, avoiding lengthy queues at the airport. It is possible to request advanced boarding too, which can make the process of getting onto the plane much easier and more comfortable.
If you require some help getting around the airport itself, you can book in-airport transport in advance. Similarly, if you require oxygen in the airport or on the flight itself, make sure you arrange this in advance with your airline.
Make sure you carry the medication you may need in your hand luggage. You may need a doctor’s note to accompany this, particularly if you need to carry needles (for example to administer insulin). Your GP should be happy to provide this for you.
Most importantly, MAKE SURE you have adequate travel insurance. Medical care abroad is extremely expensive, and however prepared you may be, you never know when you might need some help.
Always consult your own doctor before travelling
These travel tips are intended to provide general information to those who have suffered a stroke or mini-stroke and do not replace a visit to your doctor . If you are planning a holiday you should consult your doctor to ensure that you are fit to travel and discuss any specific health requirements you may have.
About Dr Ruth Handford
Dr Ruth Handford is a GP with over 10 years' experience of working in both hospital and primary care. She is particularly interested in caring for the elderly in the community, child health, and family planning. Ruth lives and works in a rural community, and is kept very busy by her job and young family.
Important Information: These travel tips are intended to provide general information to those who have had a stroke or mini stroke and do not replace a visit to your doctor. If you are planning a holiday you should consult your doctor to ensure that you are fit to travel and discuss any specific health requirements you may have
Travel Insurance for Strokes
The Foreign and Commonwealth Office recommend that you have travel insurance in place every time you travel abroad. Make sure that your insurers are aware that you have had a stroke or mini stroke and ensure that your travel insurance provides cover for this as well any other medical conditions you may have.
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