HOLIDAY Section Contents
	Information & Tips
	Holiday insurance
	Carrying your medication
	Helpful links
	Remember - always ask your Renal Unit if you have any queries.

Most people enjoy a holiday and kidney patients - and their carers - are no exception. Holidays are possible for all kidney patients as long as you are in reasonably fit and all it takes is a little planning.

When deciding on your holiday, ask your renal unit about the medical support near your chosen destination in case of emergencies. Take with you the foreign hospital telephone numbers - and - don't forget your own unit's contact number and the foreign dialling code. It is always handy to have a telephone card with you at all times that can be used to dial the UK from abroad.

Choosing accommodation - check that the accommodation you are considering is suitable for you and any special requirements that you may have. For example, if it is a hotel, do they cater for special diets? Is your apartment on a hill? How far are the shops?

TIPS FOR PEOPLE ON HAEMODIALYSIS(HD)
Travel is possible for haemodialysis patients but it has to be planned in advance. There are many holiday destinations that provide HD facilities for patients abroad. Talk to your renal unit about your plans as they may be able to provide you with details of recommended units. It is important to note that the unit abroad will need to have the same quality of dialysis treatment that you are used to.

The actual treatment may be slightly different abroad; for example, the equipment and procedures may not be the same so ask your unit what to expect so that you are prepared.

Finding a Haemodialysis unit abroad
Eurodial , based in France, publishes a directory of units around the world in booklet format and on the web. They also have a travel agency who can help with recommending accommodation, arranging insurance, and booking your holiday.

Eurodial have lists of useful phrases for HD patients, such as "the arterial needle is placed here", and "May I have a blanket", in French, Spanish, German and Italian.

Global Dialysis also has a worldwide database of renal units and lots of other useful information.

Global Dialysis is an excellent site for dialysis patients which includes a searchable database of renal units worldwide, details of kidney patient associations and national kidney charities around the world, plus lots of other useful information and links for the travelling kidney patient!

Spain - If you are visiting Spain, you will need a special Spanish form called a P10, which you will need to obtain before leaving the UK. Your UK renal unit will organise this for you.

The cost of Haemodialysis abroad
Make sure you are aware of any costs involved for your dialysis while on holiday. Some countries have reciprocal arrangements with the UK for dialysis (including the countries covered by E111 ). However, since the reciprocal agreements allow UK citizens the same care as would be provided to the citizens of the country you are visiting, there may be a portion of the cost which you will need to pay.

Transportation to your holiday dialysis unit
Make sure you make arrangements for travel to and from the unit you will be using while on holiday; how long it takes, the cost etc.

TIPS FOR PEOPLE ON PERITONEAL DIALYSIS(PD)
PD dialysis fluid and ancillary supplies can be delivered to a wide range of destinations around the world. This will be arranged through the company who manufactures them and your renal unit. However, the dialysis company needs to have details of your holiday destination, travel plans and dialysis needs well in advance of your travel date. The dialysis company will also supply addresses and telephone numbers of the nearest renal unit in the area in which you will be staying.

It is important to remember that the delivery of your PD supplies to your chosen holiday destination takes time and you will need to find out from your unit how much notice is needed. The notice required for delivery can take up 16 weeks for some destinations (the average is around 8 weeks).

When you choose your accommodation, check that:

• Your PD supplies can be delivered to your selected destination a few days before your arrival. Your accommodation (hotel or self-catering) must be prepared to receive and store this. It is important to make sure they understand the size of the delivery (for example, it could be a dozen boxes and not just a couple of bottles of medicine!). Make sure they also understand that the supplies should be stored away from direct sunlight, but do not need refrigeration.
• Make sure you call the destination 2 or 3 days before departure date to check supplies have arrived safely. Take the name of the person you speak to and ask where the supplies are being stored and where they will be when you arrive, especially if you are likely to arrive late at night or early in the morning when a skeleton staff may be on duty.
• Make sure you know who to contact if you find there are any bags or ancillary items missing when you arrive. This is extremely rare and if it should occur, the dialysis delivery company concerned will do whatever is necessary to get you what you need urgently.
  Note: your travel agent should be able to make all the above enquiries for you

Carrying out CAPD exchanges while travelling
The gold rule when travelling is - "When in doubt, don't drain out!" Always try and make sure that the environment where you carry out your exchange is clean and dust free. Better to miss an exchange and 'catch up' on your dialysis at a later time than risk getting peritonitis. It us worth noting that most people actually take more care with their exchanges when in a different environment, and the percentage of people who get peritonitis when on holiday is actually very small.

Note: If your itinerary means you won't have to carry out an exchange until you reach you destination, it is still advisable to carry one dialysis bag in your hand luggage in case there are delays.

Discuss your travel itinerary with your PD nurse who will advise you on the most suitable exchange plan for your outward and return journeys. Most airports, ports, stations and tourist attractions also have a medical room or St John Ambulance treatment room, where it should be possible to carry out a CAPD exchange - call in advance to check what is available.

Insurance of APD machines - None of the holiday insurance companies will provide cover for APD machines. It should usually be possible to arrange cover through the insurance company you use to cover household contents.

Customs - Ask your doctor for a letter confirming that your APD machine and bags of fluid are for medical treatment. The letter should also state that the bags of fluid are not to be opened.

Electricity currency (APD) - When you select your accommodation, check that there is a proper AC ground outlet (earthed), and that there is a powerpoint close enough to the bed for the APD machine to be used. Check also that the voltage and frequency are compatible with your machine, in which case you can use a good quality travel adapter suitable for your destination. If the voltage and frequency are not compatible (eg North America), you will require a transformer, which will normally be loaned free of charge by the manufacturer of your machine.

SWIMMING - Swimming is usually possible for PD patients and is a very good form of exercise. However, check with the renal unit for advice on swimming or any other sports you want to try while on holiday. NEVER bathe in water that is not clean or if your exit site shows any sign of inflammation. If you intend to swim in the sea in the UK, check out the Good Beach Guide, an independent survey of the quality of the seawater at major UK resorts and beaches.

Warming PD fluid - If you do not own a portable electric bag heater, try the following methods:

• A simple way to heat your PD bags is to use a soft cooler bag and one or two hot water bottles. Wrap the hot water bottles in a small towel to avoid overheating the fluid.
• Another way of warming the fluid is to leave it on the back ledge of a car (in summer).
• Don't heat your bag in hot water because tap water is notorious for dangerous, infectious organisms
• Don't use a microwave because it can damage the plastic covering, caramelise the sugar in the fluid (which can damage the peritoneum) and heat the fluid unevenly.

Somewhere to hang your PD bag - plastic overdoor hooks are extremely useful when travelling and can be purchased from many household stores. Avoid hanging your bag on sharp hooks or nails as there is a danger of puncturing the bag.

Waste - make sure you know how you will dispose of waste - arrangements may need to be made with the nearest hospital. Never leave waste behind in hotels or apartments - it is considered a health hazard and may deter the proprietors from accommodating PD travellers in the future.

TIPS FOR TRANSPLANT PATIENTS
Staying out of the sun
The important message for all transplant patients going on holiday to sunny destinations is - "Avoid the sun and you can avoid skin cancer". Transplant patients are three times more likely than other people to get skin cancers after a transplant because of the immuno-suppressant drugs they need to take. However, skin cancer can be avoided and, if detected early, can be easily treated.

Using sunblocks - The effectiveness of a sunblock is rated by an SPF (sun protective factor) number. The number indicates how long you can stay in the sun before your skin burns. For example, if your skin would normally burn after 10 minutes out in the sun, an SPF of 15 means that you can stay in the sun fifteen times longer before burning than if you were wearing no sunscreen; in this case that would be 150 minutes. However, this information is supplied for the general public and because some transplant medication makes the skin extra sensitive to the sun, all transplant patients are advised to use an SPF factor of 25 or higher.

Note that you cannot "add" SPF numbers. If an SPF 25 sunblock will protect you for two hours, you will need to apply a stronger SPF if you want to stay in the sun for more than two hours, rather than just applying more SPF 25.

Other simple ways to avoid exposure to the harmful rays of the sun:

• Protect your skin with suitable clothing. Clothing offers the advantages of even, non-sticky protection that you don't have to remember to reapply. However, many summer-weight fabrics don't give enough protection and fibres like cotton offer even less protection when wet. As the incidence of skin cancer is increasing globally it is now possible to buy protective clothing. Ask your pharmacist or high street chemist for information.
• Wear a wide-brimmed hat to protect your eyes, ears, face, and the back of your neck.
• Wear sunglasses that block 99 to 100 percent of UV radiation. Check the label.
• Avoid the midday sun - 10 am to 2 pm when UV radiation is strongest.
• Remember that the sun's rays can be reflected by snow, sand, water and even concrete.
• Avoid using sun lamps.
• Skin cancer and mole watch - Examine your skin regularly. If you find any unusual blemish, moles, or other marking on the skin, especially one that changes in size, shape or colour, see your doctor.
  

Avoiding infections while on holiday
Transplant immuno-suppressant drugs also reduce a patient's ability to fight infections. Simple precautions include:

• Avoid contact with people who have a cold, flu or any infectious disease such as chickenpox.
• Buy bottled water abroad or use boiled water (especially in far eastern countries).
• Avoid salads unless you have washed them and/or made them yourself, and avoid ice cubes unless you have made them from bottled water.
• Avoid ice cream from street vendors.
• Make sure you have been appropriately vaccinated.
• Avoid travelling to countries where the risk of catching an infection is high - MASTA and British Airways Clinics can help advise you on this in this section.
• Vaccinations - Transplant patients should never be given 'live' vaccines. See your renal unit for advice on live vaccines and also make sure your GP is informed. Vaccinations and advice can be obtained at your local GP clinic or at any of the British Airways Travel Clinics.

GETTING AROUND
Organise assistance at ports, airports, etc - If you tire easily, or have problems with mobility, most airports now offer wheelchairs and/or chauffeured "buggies", which will whisk you through check-in, the departure procedures and passport control in minutes. Ferry ports, railway stations and many special attractions also offer this type of assistance. You will need to book this in advance - your travel agent should be able to help you or you can simply ring direct to see what help is available and book your buggy.

A holiday can make all the difference ....

TRANSPLANT
PATIENTS
Beware of the sun!