#AskDrKK: Can patients with low Hb fly?

#DrKKAnswers:
1. Patients with hemoglobin below 8.5 g/dL generally should be given supplemental oxygen, unless the anemia is known to be well compensated.
2. Anemic patients are at risk for lightheadedness and loss of consciousness during flight, even with minimal exertion, eg, walking to the lavatory.
3. The relative hypoxia in the cabin poses a particular risk to patients with sickle cell anemia. Such patients should use supplemental oxygen and be kept well hydrated.
4. Those with sickle cell trait are not considered at risk for flights at normal altitudes under usual conditions.

#AskDrKK: Are heart patients fit to fly?

#DrKKAnswers: 

Patients with uncomplicated heart attack, or those who have undergone uncomplicated percutaneous coronary interventions should not fly until at least two to three weeks have passed and they are tolerating their usual daily activities.

Travel in the week immediately after coronary stent placement should be avoided, due to the high risk of acute stent thrombosis during this time.

Following a heart attack, a stress test is recommended in all low-risk patients.

Patients with heart attack complicated by severely depressed cardiac function or an untoward event during treatment should not fly until two weeks after they are deemed medically stable.

Unstable angina is a contraindication to air travel.

Stable angina is generally well tolerated during flight.

Severe decompensated congestive heart failure (CHF) is a contraindication to flight.

Patients with class III or IV New York Heart Association CHF should be carefully assessed to determine whether they will need inflight oxygen.

Symptomatic valvular heart disease is a relative contraindication to airline travel.

Medically stable patients with pacemakers and implantable cardioverter-defibrillators are at low risk for inflight emergencies. They should carry a pacemaker card along with a copy of the most recent ECG done with and without a magnet.

There is no evidence that airline electronics or airport security devices interfere with implanted pacemakers or ICDs.

There is a theoretical risk that the ICD might detect the alternating magnetic field created by the handheld wand, which could lead to an inadvertent shock or inhibition of the ICD's pacemaker output. Thus, patients with ICDs should request a hand search.

#AskDrKK:Can a diabetic fly?

#DrKKAnswers
1. Diabetic patients generally tolerate travel without difficulty.
2. One should wear a medical alert bracelet.
3. Preflight planning is important to ensure ready access to simple sugars and insulin, and to adjust insulin dosing schedules.
4. As a general rule, when traveling east the day is shortened and less insulin may be needed; when traveling west the day is lengthened and more insulin may be needed.
5. Insulin will denature if exposed to extreme cold and should not be checked.
6. As per American Diabetes Association, unrefrigerated insulin remains usable for up to one month if kept at temperatures below 30ºC (86ºF).

#AskDrKK: Can people with brain disorders fly?

#DrKKAnswers
1. A paralytic attack within the past two weeks is a contraindication to air travel.
2. Patients with migraines have reported travel in airplanes or trains as triggers of their headaches. The cause is unclear, and may relate to the stress of travel, sleep deprivation, high altitude, or other environmental stressors. Migraineurs, as with other patients, should be advised to maintain their prophylactic medicines and to carry rescue medication with them.
3. Epilepsy is generally not a contraindication to flying; however, patients with frequent, severe seizures should not fly until their epilepsy is better controlled.

#AskDrKK: Who is fit to fly?

#DrKKAnswers:

1. The US Air Carrier Access Act of 1986 requires that persons with disabilities are able to fly without being discriminated against. As a result, more people with chronic medical conditions now travel on commercial flights.

2. As a general rule, patients with unstable medical conditions should not fly on a commercial aircraft.

3. The Aerospace Medical Association recommends assessing fitness to fly by seeing whether a patient can walk 50 yards at a normal pace, or climb one flight of stairs without becoming symptomatic.