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If you must travel by air please read this last December 2023 was the big Ezumezu year in Igbere on 20thWednesday December 20, 2023. I received a panic call from a woman from Igbere.
She said “Dr Ojum I am with my husband at the airport but they said he is not fit to fly by air. They said the only alternative was for him to travel by road. Doctor from Lagos to Owerri is about 45 minutes by air. How can somebody who cannot fly for 45 minutes be able to sit in a car for 12 hours from Lagos to Igbere.
I explained to her and she was more confused. In the past years, I have had to educate several of my patients on why and how someone who is not fit to fly, could be fit to travel by road.
Travelling by air can cause or worsen a variety of medical conditions although very few conditions would prevent a person from flying.
Those that may prevent flying include:
•⊇Pneumothorax
•⊇Lung damage from tuberculosis
•⊇Disease that could be spread to other passengers. And
•⊇Conditions in which even a small expansion of air would damage tissues, such as intestinal surgery in the previous 10 days.
Some conditions require planning and taking precautions before flight. For example, people who have had a colostomy should wear a large bag and anticipate frequent filling.
Air travel poses problems related to changes in air pressure, reduced amount of oxygen, turbulence, disruptions of the body interna 24hours circadian clock, jet lag, and psychologic or physical stress.
Modern jet airplanes maintain air pressure inside the cabin (cabin pressure) at low levels, equivalent to the atmospheric pressure at 5,000 to 8,000 feet. At such levels air trapped in pockets within the body such as lungs, inner ear, sinuses and intestinal tract, expands by about 25 percent. This expansion sometimes aggravates certain medical conditions such as emphysema, blocked Eustachian tubes, chronic sinusitis and chronic gas pains.
Problems may be particularly severe when an airplane accidentally loses cabin pressure or when the cabin is not pressurised as in the case of smaller airplanes.
A sensation of pressure in the ears is common during airplane flight. It develops as the difference between pressure outside the ear and inside the ear increases, causing the ear drum to bulge. Eventually the pressure equalises when the eustacean tube a passage that connect the middle ear with back of the nose, allows air to flow in and out of the middle ear.
Head colds or allergies may produce fluid and swelling that block the eustacean tube, and repeated infections may result in scarring that partially blocks it. Then air becomes trapped in the middle ear, producing pressure barotitis media and pain. Rarely, the eardrum raptures.
Swallowing frequently or yawning during the airplane’s descent and taking decongestants before or during the flight can prevent or relieve these conditions.
The relatively low pressure inside the airplane also causes problems, because of its effect on oxygen levels. Low oxygen levels are particularly troublesome for people who have a severe lung disease such as emphysema, cystic fibrosis, heart failure, severe anaemia, severe angina, sickle cell disease, or certain congenital heart disease.
Usually such people can fly safely if provided with oxygen. Turbulence can cause air sickness or an injury. People who are prone to air sickness may benefit from dimenhydrate or miclizine, taken as a tablet or scopolamine applied to the skin as a patch. To prevent
injuries, passengers should keep their seat belts fastened while seated.
Rapid travel across several time zones produces many physical and psychological stresses known as a jet lag-circadian dysrhythmia. A gradual shift in eating and sleeping patterns before departure may alleviate the problem. Some medications schedules may have to be adjusted for example; the intervals between drugs normally taken at precise times throughout the day should be based on elapsed time – such as every 8 hours – rather than on local time.
People who have diabetes and who use long-acting insulin may switch to regular insulin until they have adjusted to the new time zone, food and activity level or they may make up the difference in time zone changes over several days. They should work out a medication and eating schedule with their doctor, before departure, and take with them a device to monitor blood sugar (glucose) levels with a jotter to write down, time and records of glucose levels.
Melatonin, a hormone that regulates the sleep-wake-cycle, is reported to help with sleep disturbances, caused by jet lag. Its effectiveness depends on taking the doses on a precise schedule. Because melatonin products are nutritional supplements rather than prescription drugs, the claims made by the manufacturers have not undergone rigorous scrutiny and the quality of each formulation may vary.
Fear of flying and claustrophobia can cause distress. Hypnosis and behavior modification help some people. Taking a sedative may relieve fears before and during a flight.
Because the behavior of some mentally ill people worsens during airplane flights, those with violent or unpredictable tendencies must be accompanied by an attendant, and they may need to take a sedative before the flight.
Cardiac pacemakers and metal artificial limbs, plates or pins are affected by airport metal detectors, used to scan for concealed weapons; however newer models of pacemakers can withstand potential interference from such detectors. To avoid security problems, people who wear such devices should carry a doctor’s medical report explaining the situation.
The risk of developing blood clots in the legs is increased in anyone who sits in one place for a long time.
Pregnant women and people who have poor circulation are at a particular risk. Walking around the airplane cabin every hour or two and contracting and relaxing the leg muscles while sitting help keep the blood-flowing.
Dehydration resulting from the low humidity about 5 percent in the cabin, can be prevented by drinking enough liquids and avoiding alcohol, which makes dehydration worse. People who wear contact lenses should apply re-wetting solution to their lenses frequently to combat the effects of dry air.
Special foods, including low salt, low-fat and diabetic diets, are usually available from an airline by advance request.
Travellers should pack drugs in a carry-on bag rather than in a suitcase checked in at the airplane cargo section. In case their luggage is lost, stolen or delayed. Drugs should be kept in their original containers. Travellers, who must carry narcotics, large amounts of any drug, or syringes should have doctor’s medical report to avoid being detained by security or custom officers.
Travellers may wish to carry a summary of their medical records, including electrocardiogram results; in case they become ill while away from home. Those who have a potentially disabling condition, such as epilepsy, should wear a “Medic Alert” identifying Bracelet or Necklace.
Always be medically guided.
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