My First Trip Overseas Since being Diagnosed with Heart Disease

On Friday I arrived back in Vancouver after spending four days in Delhi. It wasn’t nearly as exotic as it sounds since I spent almost the whole time in work meetings with cardiologists and heart researchers from around the world.

This was the first overseas trip for me after being diagnosed with exercise-induced palpitations and atherosclerosis. Therefore I wanted to make sure I was ready.

I had previously checked in with my employee insurance to ensure I would be covered during my trip. After that, I had to renew my beta blocker as I didn’t have enough for the whole trip. Also, as a health professional in cardiac rehabilitation, I tell patients to bring enough medication for twice the travel duration just in case they are delayed coming home.

The beta blocker pill container also has a bright yellow sticker saying: TAKE MEDICATION AT THE SAME TIME EACH DAY. Given the 12.5 hour time difference between Vancouver and Delhi, I wanted to find out what this meant in terms of when I should take it. Beta blockers are acute medications in that the protective effect only occurs when taking the medication; missing a day, means that you are not protected that day (this is in contrast to a statin I take which has a chronic, additive effect with each dose- time, and missing a dose, aren’t as concerning). In my case, my beta blocker is at its most effective in the 3 to 8 hours after taking it, so I take it in the morning in order to be protected during the waking hours when I’m most active. If I were to keep that up in Delhi, I would be taking it 12 hours later with the time difference which isn’t really taking it at the same time, or is it?

I asked my pharmacist if I should take it in the morning in Delhi to protect me during the day there or at the same time using Vancouver time. He said to take it based on Vancouver time maintaining a 24-hour interval between each dose. Okay, so I won’t be protected as well during the day. I guess that didn’t matter so much since I spent most of my days sitting in conference presentations and my heart rate isn’t likely to go up that much. Besides, half the people there were cardiologists so I felt I would be in good hands if something did happen.

To remind me when to take the pill (given I would be taking it at dinner, not breakfast), I added appointment notices into my phone calendar. The pharmacist suggested setting a repeating 24-hour alarm on my phone but I didn’t want the alarm going off at 8 pm while having dinner with my colleagues and them asking what the alarm was for. I don’t mind people knowing about my condition (otherwise I wouldn’t write about it), I just don’t need it to be a discussion point.

So with my medication regimen planned out, I made my way to the airport. As we were arriving in Delhi the pilot announced that it is was clear skies with a bit of haze on the ground limiting visibility. Having been to Delhi and other parts in Asia before, I know that ‘haze’ means air pollution. Sure enough, once outside the airport you could see and smell the pollution making things as close as ten feet away blurry. This was definitely worse than when I came before and I’m all too familiar with the negative effects of air pollution on heart disease, but I would be inside most of the time so that should be okay. Or so I thought.

In the hotel the air was definitely better but it wasn’t great and looking down the long hallways you could see the haziness of the pollution. Oddly enough there was an air quality monitor in the fitness room. On the various days it read between 60 and 90 2.5_PM (2.5_PM is the measure of fine particulate matter in the air). This was higher than the particulate matter reading in Vancouver over the summer when smoke from the forest fires blew in requiring air quality warnings. Great, so my hotel room has more pollution in it than smoke from a forest fire.

The pollution definitely had an effect on me (and others there). After a few days, my nose started to get congested most likely due to more mucous trying to prevent the pollution from getting in my lungs. My clean clothes even started to smell like they had been in a smoker and in the morning, my mouth felt like I had just eaten an ash tray.

To make matters worse, one of the presenters spoke about the adverse effects of air pollution on heart disease and highlighted that the daily reading in Delhi was over 300 2.5_PM, substantially higher than in Beijing and nearly ten-fold that in Vancouver. While listening, I kept picturing these little pollution particles getting into my blood, making their way to the arteries in my heart and banging themselves against my artery walls trying to cause problems. Perhaps sometimes ignorance can be bliss.

Now that I’m back in Vancouver I appreciate the clean (albeit cold) air and how it keeps us healthy. By having a chronic condition like heart disease, it added an additional logistic layer to planning on top of the regular things like getting a visa, exchanging currency, setting up travel arrangements, etc. In doing so, it has given me more insight to the challenges that other patients have.

I would be happy to learn about challenges any of you have had in dealing with health conditions while travelling so that we can all benefit from others’ experience.

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