Andrew Lloyd Webber has to delay opening of new musical

Andrew Lloyd Webber is said to be extremely frustrated. The doctors have grounded him, and told him they don’t want him to fly long haul flights.  He has had to delay the Broadway Opening for ‘Love Never Dies’ (sequel to Phantom of the Operat) until 2011.

The Broadway production will be delayed until next spring as  Lloyd Webber deals with “post-operative problems” from treatment for prostate cancer, according to a statement from the show’s Broadway producers. While his cancer has been “eradicated,” the statement said, his doctors have asked him to avoid long airplane flights, which apparently have aggravated his condition.

So often, after treatment, doctors blithely say , “take a break”.  But they don’t way where, and when even celebrities like Lloyd Webber can be caught out, everyone should take care.

When told you can go on holiday – it’s sensible to ask What/Where/How?

What type of holiday? and no – hiking through Patagonia is certainly not a good idea.  You just might have complications, and need to be assured that good medical attention is in easy reach.

Where? Forget about that South Sea Island with the palm-tree fringed beach.  Medical travel experts will give a no-no to anywhere long haul.  Complications with DVT are only part of the problem.  Not many people understand jet lag, but when pilots’ unions say it takes one day to recover from one hour’s flying, anything over two to three hours is too long. And again, many people do not realise how bad is the air quality on an aircraft – not the best environment when you have just come out of hospital.

How? Sitting in a low budget airline’s bucket seats is definitely a no-no.  You may think “it’s only just over an hour”.  Your body is going to say I am not feeling 100%, and definitely will play up if you sit me in a cramped cheepo seat.  And until you have done it, you have no idea how far away from the check-in desk are most cheap airline gates.  Why do you think they use these gates?  No-one else will, because they are always a long walk from the check-in area.  Hence budget airlines use them because they pay a cheaper rent to the Airport to use them.

Probably your best bet is to see if you can take a train.  With Eurostar and Rail Europe having excellent connections, you have a short walk to the train, then once on the train you can relax.  If you have booked assistance in advance (you can do this even if you just want someone to carry your bag – and until you have had an operation you have no idea how tiring it is to pull along a wheelie).  If you have to transfer trains, when you arrive at the station in Europe there will be a ground crew waiting right by your seat to take you onto the next train.  It works like clockwork, even though I always expect it won’t (Oh me of little faith!).  But you must book this 48 hours in advance.

If there is a delay, you are sitting on the train – not crammed into a departure lounge with fellow passengers sitting on the ground.

You can get up and walk around – very good for avoiding DVT, etc.

And train food certainly is better than the plastic cardboard you get flung at you onboard the aircraft.  Even BA has sent flights off recently with only a salad for First Class passengers on an eleven hour flight.  Not very nutritious.

“Love Never Dies” had been scheduled to open in November at the Neil Simon Theater on Broadway – now New Yorkers will have to wait another year whilst Lloyd Webber recovers.

For trains to Lille, Paris and Brussels:  www.eurostar.com

For trains across Europe:   www.raileurope.co.uk

LUFTHANSA GOES THAT BIT EXTRA

Most airlines say they offer help to those with disabilities – so what’s it like if you want to book a flight?

Recently we flew to Germany, and contacted Lufthansa.

They say “Lufthansa can assist passengers with mobility problems by providing a wheelchair or accepting the passenger’s own wheelchair for free. There are also carts provided at airports should transfer from gate to gate be needed”.

What they don’t say (too modest?) is that when we requested help, it came with a charming smile, allied to incredible German efficiency.

Start by phoning General Reservations 0871 945 9747  and say that you are requesting

• Help with a cart to transport you to/from the aircraft
• Requesting a wheelchair
• Requesting a special diet.

The staff talked us through what we wanted, gave us assurances that what we wanted would be provided, and references – just to confirm everything had been ordered.  Needless to say, we didn’t even look round;  at every stage of the journey there was someone looking out for us, and making sure we were looked after.

For special diets, on longer journeys they can offer around 20 – 30 different ones.  How their chefs keep track of them all I don’t know!

We were told that if we had  complex needs, if passengers had serious health problems (e.g. needing oxygen during flights, etc), please would we refer to the Medical Desk in Germany: +49 – 5 61 – 99 33 70 20 – where there is no problem with English speaking staff.

We had a trouble-free flight to Frankfurt, then just went down in a lift to catch our train from the station underneath the airport on the way to Klinic Bad Sulza.

Lufthansa also operates direct flights between London and Milan, with the flight duration of 2 hours.  They also fly from several regional UK airports direct to Dusseldorf,  Munich or Frankfurt.

www.lufthansa.com

For information re travel with disabilities:  http://www.lufthansa.com/online/portal/lh/uk/info_and_services/travel_preparation?nodeid=1770719&l=en&cid=1000243

WATCH OUT  WHEN TRAVELLING TO STATES

If travelling to countries where fingerprint identification is required, particularly the States, and you are on CAPECITABINE (Xeloda), take a letter with you from your Oncologist confirming this.

Roche (the makers) say Hand-foot syndrome (HFS) is a known side-effect of a number of cancer treatments, including Xeloda (capecitabine).  It can cause redness, tenderness, and possibly peeling of the palms and soles.

Travellers to the US have been held at Immigration for some time, as fingerprints could not be identified, due to  treatment.  The US Immigration have caused numerous problems to legitimate travellers in the past, and are not very polite, even if you have been ill.  So carry a letter with you to show to officials.

Roche says “HFS is manageable, and can be minimised with good patient management”.  Further details on the label, or  contact Roche.

DUBAI

Immigration can also cause problems, but this time it happens if you can’t produce a prescription for a drug you are carrying.  Last year a woman was held for several days, as she did not have a prescription form – for a pain killer we can buy over the counter in Chemists in the UK.

I was convinced there must be more to the story – but no, the Tourist Board confirmed that she didn’t have a prescription, but eventually she was released.  I pointed out that often we have drugs issued in hospital for which we would never receive a prescription form – but they were adamant.  Either we went to our doctor and asked for a duplicate prescription (for which the doctor might charge), or we took the consequences.

So don’t take the pain killers you have bought at Boots – quite legitimately – or watch out.

The thought of spending time locked up because I had forgotten to ask for a form for one of the many drugs I take – forget it.  There are plenty of other countries in that area who are more welcoming.

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FLYING

British Airways’ Business Class is well worth the extra, especially now they have special deals on to encourage passengers to upgrade.  If you spend time on the Internet you often find flight bookers have attractive options to offer for Business and First Class fares.

Make sure you pay by credit card (just in case…..).

If you collect Air Miles don’t forget you can buy a lot of things via their website (John Lewis, The White Company, Bodens, etc) and collect more points.  However, a word of warning if using Air Miles for a BA Business Class flight.  I used mine for a trip, and found that even though I had booked five weeks in advance, when I went to check in I had been downgraded – and only given £30 compensation for no leg room, no food, nothing to read, etc.  Not good – BA – and when they are desperately losing money, be warned by my example and make sure you have everything checked and double checked.

British Airways senior staff who look after you in Business Class are generally some of the best in the air, and their lounges are a calm oasis.  On board you get bottles of the necessary water, rather than having to keep asking (and often not getting) it doled out cup by cup. Luggage allowance is more generous, which means you can pack two suitcases if you have problems carting one large one.

Other airlines also offer comfortable Business Class fares across Europe – Finnair
has given me lovely flights, so has KLM and Lufthansa, and you arrive relaxed and refreshed,
not all squashed up.

Another benefit of flying Business Class is automatic entry to Lounges, and where there is a Fast
Track option, you by-pass that awful queue through security.  Sitting in the private lounges, if there
is a flight delay you just help yourself to another drink  or snack and read the glossy magazines.

Long Haul Flights are to be avoided at all costs.  Specialist doctors who deal with flying and travel warn that it takes on average one day to get over jet lag per hour spent flying.  I’ll never forget the Marketing Director of one of the world’s biggest hotel chains addressing a conference of travel professionals in London.  He had just stepped of the plane from Washington to tell us about next year’s plans – and to announce the room rates.  There was a gasp when he told us – then a mad rush to get outside and tell booking clerks to grab every room going for next summer.

His jet lag made him so dis-oriented he gave us rates that were half of what they should be.  That afternoon a very smart PR girl had to come and address the conference, apologise for her boss, and explain he was suffering from jet lag – and no, they wouldn’t be honouring the bookings made after his announcement.

So if it can happen to the professionals who are travelling all the time – think what it does to you.

VTE The Lancet review recently looked at many studies that research the health risks of flying and found an overall association between air travel and venous thromboembolism (VTE), which occurs when a blood clot in a leg vein travels through the body to the lung.

Smart PR: to co-incide with the review, Activa Healthcare said people  can  protect  themselves against VTE and deep vein thrombosis  (DVT)  by using  correctly fitted compression hosiery.  Activa has Unisex Socks (Class 1) that they say prevent  blood clots  from forming by applying a gentle graduated massaging effect on the ankle and  calf.   This  improves  circulation by assisting  the  body’s  own  natural
mechanism of returning blood back to the heart.  Some pilots have already started to wear these, and female cabin crew often wear support hose.

The Lancet review concluded that the risk was at its highest in flights  of eight  hours or more, but one specific study found the risk started to climb  at four  hours,  the  Lahey Clinic Medical Center team, led by  Dr  Mark  Gendreau, found.

You are also at risk of DVT if:
– You are over 40
– You smoke, are very tall, very small or obese
– You have any previous or current leg swelling
– You have a recent minor leg injury
– You have extensive varicose veins
– You are pregnant
– You take any hormone medication (Pill, HRT)
– You have suffered a DVT before
– You have suffered a stroke, or have had recent major surgery
– You are undergoing chemotherapy
– You have paralysed lower limbs

For these socks to have the desired effect, you should  be measured  by a trained pharmacist to ensure the  right size  and getting the right compression level (Class I which  is  14-17  mmHg).
For more information please ring Activa Healthcare on 08450 606 707 or visit
www.activahealthcare.co.uk.

Watch out for Terminal 5 at Heathrow  If your flight leaves from or arrives at Terminal 5, and you have just had an operation, ASK FOR ASSISTANCE.  What is it about our architects?  They are hopeless at designing buildings that work for people – they design them just to win trendy prizes.  After the debacle with luggage during the opening, now when you arrive they claim that your luggage will be on the carrousel before you arrive in the luggage hall.  What they forget to tell you is that there are no walkways that I have ever found, and it can be a good 20 minute walk from the aircraft before you get into the hall.  So if you can’t walk far, ask for a buggy to meet the plane or take you out.  It’s free.

TRAIN

Letting the Train take the strain is one of the most sensible options.  High Speed lines are opening all
over Europe, and when you take into account the time you spend getting to the airport, queuing to check-in, more time wasted waiting to go through Customers and Immigration, then longer and longer treks to the plane gate – this can take up a large amount of time.  Or you can short-cut the process by taking the train, where you are unlikely to have to queue for more than ten minutes.  Just avoid travelling during the rush hour on British trains, and book as far in advance as you can to get bargain First Class Fares.

Travelling in Britain The Great British Breakfast on our railways is still one of the most exciting ways of starting a journey; looking out of the windows when the train pulls in to Durham, and you look across at the Cathedral and the Castle has to be one of the great sights of the world. On Virgin Trains you even get breakfast included in the price of a First Class ticket during weekdays.

Travel to/across Europe, it is possible to get from London to Northern Italy in around 10 hours, and being able to stretch your legs and move around in wide seats is far more relaxing than sitting with knees squashed against the seat in front.  If you live in central London, from door-to-door it takes about the same time if you go by budget airline, or take Eurostar/TGV train.

Tip: You can now use your Air Miles for Eurostar bookings.

Now that St. Pancras Station is open it will be even easier to take a train from the Midlands and North to catch Eurostar, and times are very fast.

If you want to get across Germany, to Spain or Portugal, or Southern Italy, then modern European
trains come equipped with comfy beds and little en-suite showers on many routes – just don’t
be seduced by the Orient Express, where you pay a massive amount and no shower (not even at the end
of the corridor).

Warning If travelling by Eurostar/French railways, try and change trains at Lille, rather than
Paris.  At Lille you get out of Eurostar, take the lift upstairs for a coffee, then lift down again to
catch the next train onward.  If you change at Paris, which the French railways try to make you do,
you have to cross Paris from one station to another.  If this is unavoidable, ALWAYS take a taxi -
they cost around £10 – £15.  DON’T even think of taking the Metro – it is even dirtier than our tube,
and many stations still don’t have lifts or escalators, so your are hoiking luggage up and down.

www.eurostar.com. www.raileurope.co.uk.

And if you travel by Eurostar, you are treading very lightly with your carbon footprint.  When Eurostar found that 70% of their passengers were environmentally keen and aware, they set out to be even more environmentally friendly, even down to re-cycling those uniforms – which look much nicer as back packs and other travel goods.

CEO Richard Brown says they are “seeing passengers switching from plane to train”, and have even asked Friends of the Earth on board to advise on their ‘green’ credentials.  Now, when you travel you will find that all rubbish gets systematically re-cycled, and the packaging is much moire ‘user-friendly’.  When it comes to planes and trains, Eurostar is certainly putting its green pound where its mouth is.

European Rail is an excellent company that can tailor-make a train and hotel package for you, and Michael Birtles, their Managing Director takes a personal interest in customers. www.europeanrail.com

In a wheelchair, facilities are generally excellent. Although Eurostar say assistance can be arranged on the day by calling at the Assistance Desks on station concourses, I would suggest it is better to state your disability at the time of booking, on 08705 186 186.
Vegetarian/Vegan meal requests should be made 24 hours in advance. Special dietary requests for low salt, gluten-free, diabetic and other meals must be made at least 48 hours before booking via the Eurostar Contact Centre (08705 186 186).

The website cheapflights has an excellent page on how to talk to a genuine human being in an airline, and some travel companies.

For more information, go to http://www.cheapflights.co.uk/travel-tips/telephone-cheat-sheet/

Aalmost all the phone numbers are 0870 numbers, which for those UK-based means that the company is making extra money out of you.  0870 numbers are sneaky premium lines, and not only cost you up to 10p per minute, but the company makes money from BT as you use these.

As that annoying voice says,  “please hold on, your call is important to us” – what they are really trying to say is we are programming you to hold on so we make more money.

However, go to another website www.saynoto0870.com.  Key in company name and/or 0870 number, and up will often come the ‘hidden’ number which will be much cheaper – if not cost-free (depending on your telephone provider).

Even Ryanair’s  numbers come up.  They are all in Ireland, but then if you have one of those systems that costs you 1p per minute, you are laughing!

Medical Tourism is here to stay.  Countries are investing heavily in attracting potential clients, but unless patients take note of the dangers, and insist on checks, there is a danger to anyone going abroad for this type of medical tourism.

Questions to ask

First – what are you going to?  In many countries, there is no official definition of a ‘medical spa’ – so if this is mentioned in promotional literature look for other evidence that this is a genuine medically-run establishment, NOT somewhere for cosmetic surgery only.  In some countries they say they have a ‘medically-qualified professional’ to run the spa – but this can mean the Nurse who gives Botox injections.

In better-regulated countries, such as Italy, a medical spa is defined as an establishment run by qualified doctors, and licenced by the state health service.  If this is so, then you are generally in very good hands.

Ask – ask and ask again before you go.

Your GP should be able to get verification of qualifications.

Or, you can email and ask for qualifications of doctors whom you will be seeing, and most medical spas will respond – except in Germany where state regulates things so that no-one there ask questions, because no-one would be allowed to call themselves Doctor unless they had the qualifications.  This can make it difficult when seeking qualifications, and I have come across this when visiting rehab centres in Germany, where Doctor in charge was horrified that I questioned his qualifications!

You can always send an email to the Ministry of Health, and ask the Tourist Board representative in Britain (go to www.antor.co.uk for list).

And beware in Britain -  our term ‘MediSpa’ is a marketing ploy.  And sadly, if you ‘Google’  medical spa, up will come a list of spa associations specialising mostly in cosmetic procedures, and ‘wellness’;  you might find websites that give you details of what is required by State law, only to find it is concerned with Health and Safety, Zoning laws, local regulations for buildings, but nothing to do with medical background.

So ask and ask questions.  If you find the right place you are really going to do yourself good – but you don’t want to waste your money.

Is Rabies present?

The recent death in Northern Ireland highlighted that this is a deadly killer disease; anyone bitten by a rabid dog will die, unless given preventative vaccine, and we now know rabies can be transferred from one human’s organs to another.

Yet how many medical tourists looking for organ transplants abroad will query if the donor has been tested for rabies?  Even though it has now been discovered that rabies can be transferred this way?

What happens if something goes wrong?

Ask any British GP how many patients return with problems after procedures, from dental work to hip replacements carried out abroad, and they can tell of cases which have to be sorted out by private or NHS doctors in Britain.

If the package offered looks too good to be true – it probably is.

Medical Tourism is now big business, and like all businesses, companies want to make a profit.  Some countries do offer very good value for money;  many cancer patients, such as Kylie Minogue, choose to be treated in France, where post cancer survival rates are far better than in Britain.

Malta is another country where many of the medical staff have been trained in Britain, and top British Consultants work there as they like working with well-trained English-speaking staff.  The Maltese Government is making available £40 million for patients wanting loans for medical treatment.

In your GP’s surgery you may come across the National Association of Primary Care’s backing for a magazine, highlighting treatment options in other countries.  Patients will see these articles and assume treatment abroad will be like a holiday, but as John du Vois, spokesman for AXA PPP Insurance says, “one should go in to this with eyes wide open”.

Currently most tourists going abroad for medical treatment assume going in to hospital will protect them from complications, but travel expert Alan Bowen of AGB Associates comments “most travel insurance policies will almost certainly specifically exclude all forms of medical treatment, if that was the reason for the travel in the first place”.

Problems arise when patients fly to an idyllic destination for treatment, simple procedures go wrong, and the nearest major hospital capable of dealing with an emergency is a long boat or plane ride away. Or undergoing an organ transplant, something goes wrong: Google has pages of examples.

When Kris Shastri of InsureCancer saw a gap in the market for patients who couldn’t access reasonably priced travel insurance, he developed a pioneering insurance risk assessment and underwriting methodology to provide this, and recently has been considering extending travel cover for medical tourism.  He asks searching questions about the names of doctors, clinics or hospitals, and then checks these to ensure the care offered is of the best.  If he refuses you insurance, it is for a good reason.

So before you are seduced by glossy brochures showing patients strolling arm-in-arm with a pretty nurse under palm trees – check if anyone will insure you.  It might save you from making a dreadful mistake.

Medical treatment won’t protect you from other ‘nasties’.

Make sure all your relevant injections and vaccinations are up-to-date.    www.fitfortravel.scot.nhs.uk This is a very efficient website;  I checked for France, and it even recommends vaccination for tick-borne encephalitis (good idea if you go to campsite) which is being extremely thorough.

Medicines

Take an adequate supply (and keep these in hand luggage).  If you have to obtain these from chemist locally, you might have to pay as you probably won’t get NHS funding.  Also, take the prescriptions in case your doctor needs to question anything, or if going to countries such as Dubai you will get officious Customs officials who might threaten to send you to jail if you don’t have this.

Alcohol

Doctors will usually be pleased if you have one glass, but just because you are abroad and the wine is wonderful, DON’T go overboard.  Not only can too much alcohol cause havoc with drugs, but if you fall down or have an accident, today most insurance companies could use that as an excuse for refusing to pay out.

Tell your Insurance Company

the moment anything happens on which you might want to claim.  I thought I was handling my bite from a rabid dog, but when I arrived home in London and called the insurance company, they said they wouldn’t pay out because they hadn’t pre-authorised the treatment.  And Keep Receipts – even from the taxi that takes you to hospital.

EHIC CARD

If you are going to Europe, even if you have private medical insurance, you must also have a European Health Insurance Card (EHIC).  This is to show you pay taxes and are entitled to NHS treatment, and has to be shown when receiving emergency treatment at most European hospitals.

Frankly, their standards are so much higher than ours in many cases, that you may not realise that you aren’t being treated privately!  The card entitles you to free care, but if you don’t have it, and you have been treated under another country’s national health service, your insurance company either won’t pay, or will bill you for difference.

However, because of this card, you will probably find your medical insurance premium has gone down – or at least kept level.

To get a card you go to www.nhs.uk/ehic  or call 0845 606 2030  or complete an application form available in your local Post Office (if you still have one).

However, you must have private insurance as well – EHIC doesn’t cover things like repatriation if you need to be bought back home, and certain private clinics services, etc.

If you are travelling for treatment to improve your health, it makes no sense to try and save a few pounds on air fares.  Most budget airlines now charge extra – a lot extra – for luggage, and with some you are expected to carry it all the way to the plane yourself, or else pay heavily for it to be carried for you.  You won’t be able to use trolleys, and budget price airlines don’t pay for the Gates near the Lounge, so you end up walking miles – literally.

You can even find you end up paying more for a flight, or worse – if the airline decides to cancel the flight you have very, very few rights.  Just try suing and you soon find out how little protection you have, and how much a ‘cheap’ flight can actually cost.

Far better to treat the travel as part of your holiday or trip, and set out to have a fun trip.

There are lots of ways to do this – and as a person who loves to travel in comfort, I have a few tips which I hope will be helpful for keeping down costs.

Balneotherapy (from Latin: balneum, “bath”) Wikipedian says this  is the treatment of disease by bathing. It may involve hot or cold water, massage through moving water, relaxation or stimulation. Many mineral waters at spas are rich in particular mineralssilica, sulfur, selenium, radium) which can be absorbed through the skin. Medicinal clays ( are also widely used.

The term “balneotherapy” is generally applied to everything relating to spa treatment, including the drinking of waters and the use of hot baths and natural vapour baths, as well as of the various kinds of mud and sand used for hot applications. Balneotherapy refers to the medical use of these spas, as opposed to recreational use.

Common minerals found in spa waters are sodium, magnesium, calcium and iron, as well as arsenic, lithium, potassium, manganese, bromine, and iodine. Resorts may also add minerals or essential oils to naturally-occurring hot springs. Though balneotherapy commonly refers to mineral baths, the term may also apply to water treatments using regular hot or cold tap water.

Mud baths are also included in balneotherapy, and the dirt and water used to mix mud baths may also contain minerals which are thought to have beneficial properties.

Treatment bath at a spa in Hot Springs, Arkansas, United States

Balneotherapy may be recommended for wide range of illnesses, including arthritis , skin conditions and fibromyalgia . As with any medical treatment, balneotherapy should be discussed with a physician before beginning treatment, since a number of conditions, like heart disease and pregnancy, can result in a serious adverse reaction.

Scientific studies into the effectiveness of balneotherapy tend to be neutral or positive, finding that balneotherapy provides no effect or a placebo effect, or that there is a positive effect. However, many of these studies suffer from methodological flaws, and so may not be entirely reliable.  The best guide is to find out if the spa is registered or known to the medical profession, recommended by your doctor, or has a reputable medical team in charge.