Spring break fever has arrived-many are eagerly leaving behind school and work to venture to warmer locales for much-needed rest and relaxation. However, vacation can bring its own stresses, especially with packing and preparation. While traveling can be stressful for anyone, it can be extremely challenging for people with health issues, including those whose health circumstances require intravenous (IV) nutrition, which helps to feed patients who are unable to consume nutrients orally because of a health condition or non-functioning gastrointestinal tract.
It's easy to understand the source of travel anxiety for people who rely on IV nutrition, also known as parenteral nutrition. There are several challenges these patients may face when traveling, which are related to the medically necessary supplies and life-sustaining therapy they must carry with them on a trip.
"Nutrition support often requires large amounts of liquid therapy and equipment such as medical sharps, which can be difficult to take through security," says Mark DeLegge, MD, global medical director at Baxter Healthcare Corporation. He cites refrigeration as another concern, as some IV nutrition treatments must be kept cool to preserve the contents and avoid spoiling. This can be particularly challenging if patients are traveling by bus, train or car, which have limited and often unrefrigerated storage spaces.
The good news: with advance preparation and treatment considerations, travel can be an enjoyable reality.
For example, IV nutrition has not deterred Seattle resident Sandy Schwarz from pursuing her lifelong passion of traveling despite her constant pain and nausea. Sandy lives with gastroparesis, a condition that reduces the ability of the stomach to empty its contents. She also has Crohn's disease, a form of inflammatory bowel disease that usually affects the intestines. Additionally, Sandy has an ileostomy, a surgical opening in her belly that allows for the collection of waste outside of the body when the colon or rectum is not working properly. Her severely debilitating conditions often make it hard for Sandy to get out of bed, and she requires IV nutrition to receive the nutrition she needs as part of her daily living.
Despite her condition, Sandy has not abandoned her dreams of traveling. With the support of friends and family, she has traveled far and wide and recently traveled to Hawaii, China, India, England and Germany. She accomplished this all while receiving IV nutrition support and extensive recuperation in between her trips. With a great deal of passion for traveling and technological advances, Sandy has been able to accomplish her dreams.
Patients and clinicians alike agree that a little preparation can go a long way. Following are some tips to help any vacation with IV nutrition go smoothly.
1. Understanding the Treatment Options.
Before Sandy's recent travels, her sister, a dietician, learned of an IV nutrition treatment that could be transported and stored at room temperature, with no refrigeration required while still in the packaging.
CLINIMIX E sulfite-free (Amino Acid with Electrolytes in Dextrose with Calcium) Injections are manufacturer-prepared, sterile IV nutrition products that come in multi-chamber containers that separate the essential ingredients (protein, carbohydrates and electrolytes) until they are needed. These formulations can be safely transported and stored at room temperature, with no refrigeration required when the outer packaging is still intact. Maintenance vitamins, additional electrolytes and trace elements are not included and should be administered as required.
"I used to have to get creative," says Sandy. She would use collapsible coolers, stay in rented apartments with refrigerators - she even used frozen peas to try to preserve her medication when ice machines weren't available.
CLINIMIX E Injections were an appealing choice for Sandy as she planned to travel extensively in China and India and wasn't sure she would have access to proper refrigeration.
2. Ensure adequate supplies.
Make a list of medication and equipment needed for travel, and plan to pack a few extras in case of loss or damage.
"My biggest fear in traveling is whether or not I've brought all of my medications and equipment," Sandy said. For Sandy, this means not only keeping track of medicines, but also all of the daily supplies for keeping her treatment tubing clean and sterile. As one of her pre-planning tasks, she creates a spreadsheet to track her daily medication and supply needs and gets copies of her medical records to have with her at all times. She also suggests having a plan of action in case of emergency, including identifying hospitals where care is available in case of illness or other complications.
When packing, be sure to research airline baggage weight limits, as these may vary per country or consult with a travel agent.
Storage is an important consideration, too. With treatments like CLINIMIX E Injections, the therapy stays fresh when stored in its outer packaging at room temperature. Once the product is removed from the packaging, it can be refrigerated for up to nine days prior to administration if supplementary vitamins and minerals have not been added. For those solutions/formulas that need to remain constantly cold, experts recommend using cooling packs and covering with ice. When making a hotel reservation, be sure they can guarantee an in-room refrigerator or space in their kitchen's refrigerator.
3. Consider pre-shipping medical supplies.
"Supply availability and access can be challenging, especially if a person who relies on IV nutrition is traveling to multiple destinations or for an extended period of time," DeLegge says. He suggests that it may be better to have supplies shipped ahead of time through a patient's home healthcare provider, which can make spontaneous travel more difficult. Treatment needs should be coordinated with a patient's physician and homecare provider well enough in advance of travel to ensure adequate therapy arrives safely to a travel destination.
4. Bring paperwork.
Security organizations, such as the U.S. Transportation Security Administration (TSA), are becoming much more accustomed to seeing patients travel with medical supplies. To make the process even more seamless, experts recommend that travelers carry a letter of medical necessity from their physician that explains their conditions and treatment in consumer-friendly terms to help expedite the security process. Whenever possible, patients should have the letter translated into the local language of the country they are visiting.
"While you and your doctor are familiar with the condition and its treatment, travel officials may not be, and this additional context may help to ensure a more seamless travel process," DeLegge adds.
5. Enlist support.
Sandy recommends traveling with companions to make travel easier. She also uses smart technology that enables her to track her list of treatments, set multiple alarms so that she knows when to take her medication in any time zone, and email her doctor and family as needed.
The Oley Foundation, the only North American-based group for people taking IV and tube-fed (enteral) nutrition, offers additional helpful tips for travelers. Patients considering travel for the first time may benefit from attending Oley's annual conference June 25-29, 2012, in Redondo Beach, California. Participants have the opportunity to meet with other people taking IV nutrition who have extensive travel experience. Additionally, the meeting organizers have put safeguards in place to help ease the travel process, including nurses and pharmacists on-site to help in case of emergency. Patients seeking more information on the conference or on tips for travel can visit www.oley.org.
"Travelling enhances our lives. Do not be limited by the need for parenteral nutrition. Choose your destination. Then utilize resources available through the Oley Foundation and begin your planning by speaking to others who have experience navigating with solutions, supplies and equipment," says Joan Bishop, executive director of the Oley Foundation.
6. Remain optimistic.
It hasn't always been easy for Sandy and still isn't. A few years ago, she stopped traveling for a while after a period of numerous surgeries as she was feeling severely run down.
But she decided, "I can get sick anywhere, at any time, and I wasn't going to let that rule my life. I would rather live a life than wait for the next medical emergency to come along."
Sandy reflects back on all of the sights she's seen in the last few years - not just the typical tourist destinations but also the hidden neighborhoods in Beijing, China, and the view from a houseboat on the backwaters of Alleppey, India.
"Everyone needs something that gets them excited, that makes their day and gives them a reason to live. Having a chronic condition sometimes means you have to be a little more resourceful," says Sandy. "I had dreamed of going to India for 30 years, so this was a victory for me." She's already seeking ideas for her next big trip.
Important Risk Information for CLINIMIX E Injections
- It is essential that a carefully prepared protocol based on current medical practices be followed, preferably by an experienced team. Frequent clinical evaluation and laboratory determinations are necessary for proper monitoring during administration.
- CLINIMIX E Injections are contraindicated in patients having intracranial or intraspinal hemorrhage, in patients who are severely dehydrated, in patients hypersensitive to one or more amino acids and in patients with severe liver disease or hepatic coma. Solutions containing corn-derived dextrose may be contraindicated in patients with known allergy to corn or corn products.
- Because of the potential for life-threatening events, caution should be taken to ensure that precipitates have not formed in any parenteral nutrient admixture.
- Use with caution when administering to patients with kidney disease, lung disease, or heart disease. The intravenous administration of these solutions can cause fluid and/or solute overloading resulting in dilution of serum electrolyte concentrations, overhydration, congested states, or fluid on the lungs.
- Metabolic complications have been reported, such as acid-base, electrolyte, and blood glucose imbalances, elevated liver enzymes, and increased urination and dehydration.
- Other adverse reactions that may occur include fever, infection at the site of injection or other IV access complications and fluid volume overload. The infusion of hypertonic nutrient injections into a peripheral vein may result in vein irritation, vein damage, and blood clots.
- This product contains aluminum that may be toxic with prolonged parenteral administration if kidney function is impaired.
- CLINIMIX E Injections must be admixed prior to infusion.
Full Prescribing Information for CLINIMIX E Injections is available at www.clinimix.com.