[00:03]
Emma: It’s a pleasure for me to introduce our final speaker, who will be presenting on travel and myeloma, a topic we hear brought up again and again at our support groups and on our Telephone Support Line.
Jo joined Myeloma Australia in 2008 and is a Senior Specialist Myeloma Nurse. She has worked and volunteered for Myeloma Australia for over 12 years.
Jo has over 30 years of experience in a range of haematology nursing roles, from clinical and coordination to research. Based in Adelaide, Jo also works for Cancer Council services at Royal Adelaide Hospital as a myeloma research nurse.
Jo is a mum to three adult children, loves the family shack on the water, enjoys gardening, bushwalking and camping. She also enjoys being creative through drawing and painting. Welcome, Jo.
[00:58]
Jo: Thank you, Emma. It’s lovely to be here this morning, and I’d love to thank our previous two speakers who have given us that bread-and-butter overview of myeloma.
I’d just like to change tack now. We have a focus on wellbeing for our seminars this month, or for 2022, and I think going travelling is something that gives us the opportunity to look at our potential and what opportunities we can achieve.
Today I’d like to look at things we should be considering when we are planning travel, particularly what is related to myeloma.
[02:13]
There are various things we need to consider, and that is what I am going to run through.
Planning a holiday will involve more thought and consideration to take into account what you can and can’t do with a myeloma diagnosis. But it won’t stop you from being able to travel, especially now that we are able to open up and travel more after the pandemic.
[03:04]
When you are planning a holiday, it is really important to discuss your travel plans with your doctor before you start making any bookings, to ensure that the plans you are making are appropriate for your myeloma situation at that time.
Once you have discussed your plans with your doctor and know how long you are going to be away, you can ask your doctor to write enough scripts to cover your regular medications for the whole trip. It is also helpful to have extra medication in case of delays, or loss of tablets or medication.
The common oral medications for myeloma, thalidomide, lenalidomide and pomalidomide, have recently been made available on a three-month supply for men and women of non-childbearing age.
A three-month supply may be available to you if your haematologist feels that your myeloma is stable enough for you to be away for an extended period of time.
Other things you will need to discuss regarding medications include a range of supportive care options, such as antibiotics in case you get an infection. Scripts can be written and filled for you to take with you.
[04:44]
Also discuss with your treating team whether you can request a letter with a brief history of your myeloma, when it was diagnosed, what treatment you have had and what the responses have been, including your current situation.
That will be helpful if you need to get medical attention while you are away. This letter should include contact details for your treating team, especially your haematologist, by phone and email.
It will be important for any doctor overseas to be able to discuss any further queries or questions with your haematologist.
When you are planning your itinerary, it is also a good idea to have contact details for myeloma specialists who are at the destinations you are travelling to, especially if you are going to be there for any length of time.
You will also need to discuss what vaccines you can have that are appropriate for your destination, and what vaccines are appropriate for you. Some vaccines are live vaccines and are not appropriate for immunosuppressed people, so you will need to discuss this with your doctor.
Also make sure that your COVID vaccinations and your current flu vaccination are up to date before you travel.
Some insurance companies will require a letter from your haematologist stating that you are fit to travel, so that is another document to request.
[06:40]
International travel will be the main focus of the rest of this talk.
There are 11 countries that have reciprocal health care agreements with Australia, and they tie into our Medicare program, but each has its own conditions to meet.
This can be researched on the Services Australia website, which has the current listing of countries available under this scheme.
This means that travel insurance for your myeloma may not be required in those countries.
If you are travelling within Australia, domestic travel medical expenses are usually covered by your private health insurance and Medicare. Claims through private insurance are usually made first, and then Medicare may cover the gap.
Check with your private health insurance company, if you have it, to confirm exactly what they will cover while you are away.
Also discuss with your treating team how stable your myeloma is. If your myeloma is well controlled and your holiday is only for a few weeks, your risk may be lower.
Myeloma can be excluded under cheaper travel insurance policies, but those policies may still cover unforeseen health issues.
[08:31]
Looking at travel insurance for pre-existing medical conditions, this is where myeloma sits. It needs its own separate declaration and cover.
Under Australian law, insurance contract regulations define pre-existing medical conditions as those that exist six months before the contract was entered into and continue after that contract was signed.
Unfortunately, insurers can get around this six-month rule by specifying exclusions or limitations in their product disclosure statements.
You may find that insurers generally cover a condition if it has not led to treatment for two years before you book your trip. In other examples, insurers may specify five years or longer.
There is great variation between what insurance companies offer, so you need to explore your different options.
On the CHOICE website, which is a paid website, you can pay to explore travel insurance guidelines. It is something the Australian Government travel website recommends you consider.
[10:10]
Give yourself enough time not only to plan, but to research. Apply for your travel insurance at least a month before you leave so you can find the best cover for you.
CHOICE recommends getting at least three quotes because responses from companies can vary considerably.
You must declare your existing medical condition or conditions, myeloma being one of them. These conditions are listed specifically on insurers’ websites, and you may have more than one.
You may need to answer an extra set of questions. All companies provide an online questionnaire, but people I have spoken to who have gone through this process have found it easier to ring and speak personally to a consultant who can help walk them through the form, the process and the type of answers required.
Just remember, if you are diagnosed with smouldering myeloma, emphasise that this has no symptoms and no treatment. Therefore, it should not be considered a risk factor under existing medical conditions.
If your myeloma is less stable, or you are planning to travel more than once a year, you can take out an annual insurance policy. This will be more expensive upfront, but it might be more economical for you in the long run.
[12:06]
Before you book online, it is a good idea to call the individual insurer and discuss how the policy works for your situation.
Another recommendation from CHOICE is that if the online quote is out of your price range, let the insurer know and explain your situation. You may find that they are able to offer cover at a cheaper price.
If not, CHOICE suggests declining the offer, as the insurer may come back to you later with a better offer. There are some testimonials about this on their website.
It is recommended that at least one travelling companion is insured on the same policy, so that someone can accompany you home if you become unwell and be covered under the same conditions as your insurance.
If you are travelling with a wheelchair, mobility aid or other expensive medical equipment, you will need to insure that as well.
Apparently, in the fine print, many insurance companies do not cover hearing aids because they are so easily lost, and you may have to cover them under a separate policy. So, just be aware of that.
If you are unable to get cover for your pre-existing medical condition, or the cost is prohibitive, you can still purchase a travel insurance policy. It just will not cover your myeloma.
Interestingly, Smartraveller, which is the Australian Government website, has found that more than two out of three people travel without insurance to cover their pre-existing medical conditions.
[14:11]
Now we are going to look at some practical considerations about you, your myeloma and your travel.
Before you travel, check the government Smartraveller website for travel advice, alerts and warnings for the destinations on your itinerary.
Subscribe to Smartraveller for updates about those destinations. This will also register your travel plans with the Australian Government.
Download the “before you go” checklist to make sure that you have everything done prior to departure.
There is also an area where you can check restrictions on bringing certain drugs into your destination countries. You may need a letter of authorisation for those drugs, or for equipment you need to deliver them, such as syringes and needles.
[15:14]
While you are away, carry your important documentation, medical letters and enough medicines and equipment for a few days in your hand luggage. If your main luggage is lost or delayed, this will give you a little bit of wriggle room while you make alternate plans.
Keep your medicines in their original packaging. Do not just put them into bottles or other containers for ease of packing, because they may be confiscated at border checks. They must be labelled with their original labels from the pharmacy.
Keep a list of all the medications you are taking. This will help if you need replacements, and it will also help if you are seeking medical assistance while you are away.
Take a thermometer and monitor your temperature if you are unwell.
Use hand sanitiser and wipes regularly, and wear a mask in public areas. We have all had plenty of practice with this during the COVID pandemic, and these precautions should be continued while you are travelling.
We also recommend that you eat freshly prepared meals and avoid food from a buffet or smorgasbord. These can be a source of infection for people who are immunocompromised, and even for some people who are not.
Please keep your medical receipts for your expenses so you can make a claim when you return from your holiday.
[16:56]
There are some considerations to think about when flying.
Will you be travelling alone or with a companion? Will you need assistance navigating through the airport, or assistance with your baggage and boarding the aircraft?
Will you be able to use the toilet on the plane? Will you be able to hear or read the safety briefings and instructions from staff?
Some airlines have braille and large-print versions of their safety leaflets available, but you will need to request them.
To address some of these points, under disability access guidelines from the Australian Government, airlines and airports have a responsibility to provide services for people with disability.
Trained staff should be able to assist with getting around the airport, handling baggage, getting on and off the plane, delivering safety briefings in a way that all passengers can understand, opening packages and identifying food served on board, and getting to and from the plane toilet.
Plane toilets are notoriously small and cramped. If you feel you may not be able to manage in the space provided, some airlines can provide a privacy curtain that can be put up so the door can be left open and you have a little more room to manoeuvre.
There are certain things that, under these regulations, staff are not expected to assist with, such as feeding, administering your medication, actually using the toilet, lifting a passenger or physically helping with movement.
These are all things you are entitled to request assistance with.
[19:12]
Some final thoughts I would like to leave you with about the prospect of travelling.
You have worked really hard during your treatment to regain control of the myeloma and maximise your quality of life. Now is the time to do the things that you love to do.
While things have changed for you, there is your new normal, and travel is generally feasible. Embrace what you still love to do, including travel.
Post-COVID, the world is opening up, but you may want advice on that, so please discuss this with your haematologist.
Planning well is absolutely key for an enjoyable and successful trip, and you never know where you might end up travelling to.
[20:13]
This ties in beautifully with our Joyful Moments campaign that you saw the video of earlier and that Hayley mentioned at the start of today.
Myeloma Australia wants to celebrate what makes you, you. We want to hear about all your hobbies and interests, and that includes your travel.
We would love you to send a photo or video of you doing that thing that makes you feel joyful, or your travel photos, whether that is something recent or still ahead of you.
We would like you to complete the sentence: “I’m a 38 Mate and I love…” or “I care for a 38 Mate and I love…”, and email that with your photos and videos to us.
We will share your photos and videos as part of our focus on this month’s myeloma awareness of wellbeing and possibility.
Thank you very much for listening, and I hope that has given you some inspiration to go travelling. Thank you. Bye.
[21:21]
Emma: Thank you so much, Jo. It is really exciting that we can start to think about travel as a possibility again.
We have a couple of questions. The first question is from Nicole. Is it possible to travel to Africa with yellow fever? Do you lose all vaccination protection after a stem cell transplant?
Jo: Off the top of my head, I am not sure whether yellow fever is a live vaccine or not. This is a specific question for your haematologist.
As far as the stem cell transplant goes, yes, you do lose your vaccination memory. That is why, six months post-transplant, there is a full vaccination schedule that patients undergo to reinvigorate the memory of the common vaccines.
Like all travellers to countries with high-risk diseases, you would need to have specific vaccinations and seek guidance from your haematologist on that.
[22:36]
Emma: Thanks, Jo. The second question is from Stephen. Can you please advise about safety on a plane? I had a stem cell transplant 30 days ago and I am flying in about 60 days. Masks worn on a plane? Any other suggestions for immunocompromised individuals on planes?
Jo: All airlines still require you to wear masks. You may want to think about, if it is domestic travel, an upgrade to the front of the plane where there is a little more room. Obviously, that is a bigger cost if you are travelling overseas.
Make sure that you have a good-fitting mask, such as an N95, and that your vaccines are all up to date, including your COVID vaccines.
Speak with your haematologist about what you should do if you are away and you suspect that you might have COVID.
If you are in Australia, there are preventative or antiviral medications that can be given. You will need to know where you can access those at your destination overseas.
This is an evolving area for us and we are learning as well, so you will have to investigate what is available or required in the countries you are travelling to.
Your travel agent may have more specific information about what is required in the country you are travelling to.
[24:19]
Emma: COVID definitely adds that extra layer of planning and thought when we are travelling now.
Thank you so much again, Jo, for joining us today. As I said, it is very exciting to think about travel again after the last couple of years of lockdowns and the pandemic.
