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6 It is recommended that you contact your MS Nurse and Neurologist before booking your overseas trip. This ensures that all options and issues can be discussed. Air Travel and MS Therapies For international air travel you will need a letter from your Neurologist that includes: A summary of your condition. Medication information including trade and generic name, dosage, frequency and amount that you are carrying. States clearly that the medication is for personal use. If you are intending to carry 3 to 6 months supply of your medication make sure you letter explains why you have this much (for example extended travel). *This letter will also be of assistance if you need medical attention while you are travelling. Photocopy this letter and keep one with your passport for customs and one in your luggage. TIP:Your Neurologist s secretary or your MS Nurse can often organize the letter without needing to see your Neurologist. Give at least two weeks for the letter to arrive.

7 You will also need to: Ring your airlines to notify them that you are travelling with medications for MS that include needles and syringes. Remember to keep the needles and syringes in their original box that has the pharmaceutical pre-printed label on it. Most airlines have a policy of not refrigerating medicines, so come prepared (see how to store your medications ). Airline Websites For example, (follow the prompts to special needs) Australian Government Department of Foreign Affairs Smart Traveller Phone Service Hour Consular Emergency Centre or Medicare website, gives information on PBS Scripts and safe travel with medications or

8 For domestic air travel your script is all that is required for security check, but it may also be useful to carry a letter from your Neurologist. Remember to keep the medications in their original box. For local travel, such as camping, you will need to think about: How you are going to keep your drugs cold? How you are going to store them safely? How to dispose of them, and What you will do if you run out or lose your medications? You might consider options such as ice from the nearest town, a car fridge or caravans that have a freezer/ fridge. The most important thing is to have a plan organised. It is important to discuss this issue with your Neurologist and travel doctor. Make sure you organise an appointment at least 6 to 8 weeks before travelling. Your travel agent will have a list of local medical

9 Make sure that you organise appropriate and comprehensive insurance.

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11 There are a number of different types of insurance cover available, including medical cover, personal liability, baggage loss, travel delays and cancellation or curtailment. Make sure you match your travel plans and destinations with the insurance cover you will need and check the details. When buying insurance you might like to consider options other than your travel agent. If you are able to, insurance websites, insurance companies direct or services such as financial planners often have lower costs and are willing to forgo commissions that travel agents make ( this can save you up to 40%). When purchasing travel insurance, in most cases MS is considered a pre- existing illness and will require you to complete a medical assessment form. This form is sent to the insurance company to evaluate if they will give you insurance and under what conditions, such as extra payment. You may want to check out a number of companies and see what response you get so you can haggle for the best deal! TIP:-take a copy of the insurance policy for your MS Nurse or Neurologist to review before you sign it. Many Neurologists and MS Nurses have a list of insurance companies their patients have used in the past that you may find useful.

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13 Remember that the medications need to be kept in their original box with the professional pharmaceutical pre-printed label on the outside. This is the primary customs clearance check. Take the medications and equipment on as hand luggage and make sure it is easy to access; you will need to get them in and out for security. At Security checkpoint you will need to put the medications through the x-ray exposure. Studies have shown that this small exposure is of no risk to the formulation of the medications. You will need an Insulated bag for storing your medications. Make sure that you clearly label the bag with your name and contact information. Your MS Nurse can help you arrange one if you need it. You will also need two ice bricks to keep in your insulated bag. Check that your supplies fit or you may need two insulated bags. Ice bricks remain cold for 24 hours and even if they have melted the insulated bag will remain cool. TIP: Store your medications and needles in a waterproof bag (glad wrap snap bags are good) so that if the freezer bricks melt your needles and syringes do not get soggy!!!

14 Your medications and equipment need to be taken on the plane as hand luggage. If you store them in the hull with the rest of your luggage they may become frozen, misplaced or lost. Airlines DO NOT STORE DRUGS in their fridge as these are food fridges. You need to be self-sufficient and ensure that you have planned ahead. Airlines will supply ice for your storage bags. Check with your travel agent that the room that you have booked has a fridge or that the guest house/ back packers has a fridge. If it is a communal fridge you may wish to use the fridge to re-freeze your ice bricks and store the drug in your room. TIP: Other traveller s tell us that it is helpful to know a few basic words (like freeze ) in the spoken language of where you are travelling so that you can communicate to people that you need your ice bricks frozen. It may also be useful to take a supply of large sealable Glad bags so that you can place freezer blocks inside and label with your name and room number. This is especially helpful if you have to store them in kitchen freezers in hotels.

15 MS Relapse If you have a relapse, don t panic! One of the best things you can do is rest, if things get worse and you require medical intervention, most insurance policies have a number to call or alternatively you can contact the local Australian Embassy.Many insurance companies will provide you with a contact card to carry with you that has 1800 numbers on it to call for medical advice or in case of an emergency. Lost Drugs It may be distressing if you lose your medications but the active ingredient in the drug stays in your system for quite a few months so you will still be getting some benefit. If travelling internationally, the high cost of replacing the medications and the hassle to get a script is not usually worth it. En-Route administration of medications Please discuss with your Nurse or Neurologist if the timing of your flight coincides with your injection regimen. Please also discuss the effects of jet-lag and the time zone changes.

16 Mobility - Things to consider Do you need a seat near the toilet or the front of the plane? Do you need an aisle seat or a seat with a flip up arm rest? *When booking your flight you can view the seating arrangements and discuss with the travel agent what seats would be best. Wheel chair access in hotels and on the plane -If you require wheel chair access check that the plane has on board wheel chair access and if necessary, storage for mobility aids and electronic scooters. Also check your hotel (including bathroom and toilet) has wheel chair access. Make sure you allow plenty of time for flight transfers. Find out about local public transport at your destinations to see if it accommodates for disability. Wear shoes that you can easily get on and off for comfort on the flight and security check points. You might also like to consider specialised flight socks or stockings that reduce swelling in your feet as this is common on long flights, particularly if you have reduced mobility. You may also need to discuss prevention of deep vein thrombosis with your Neurologist before you travel. TIP:There are strict policies about medical supplies and equipment on most airlines. Some need to be made available for inspection and clearance before departure and electric wheelchairs may need to be disassembled for the flight. Make sure you check with the airline if you have any equipment you are taking. Also check the voltage and adaptor configurations at your destination.

17 Fatigue Do you need wheel chair assistance at airports and between terminals? Have you planned your sightseeing to take in fatigue and heat? Check that your motel/hotel is centrally located to what you want to see and do. Use a wheelchair when you can for Museums, Zoo s and large shopping centres. TIP: Use a walking stick that converts into a stool to maximise rest! Bladder Management Do l need to have a supply of pads with me? Do I need a spare change of clothes just in case? Is my seat request near toilets? TIP:Air travel is very dehydrating, so drink enough fluids to avoid dehydration as this can lead to increased risk of bladder infection!

18 Heat Be prepared for all weather conditions! Discuss with your Neurologist or MS Nurse what is called Uhthoff s phenomenon. This is when an increase in temperature causes transient neurological symptoms. You can decide what to do if it happens and options for cooling methods. Useful Information Contacts Websites: Access to the World. Specialising in holiday travel for people with disabilities. While every effort has been made to ensure that the information given in this travel brochure is up to date and accurate, this travel brochure is meant as a guide only.

19 NOTES Supported by an unrestricted educational g

20 NOTES