By Steven E. Lo, MD

Winter time brings forth holidays and many opportunities for travel. But those with Parkinson’s disease often times face challenges when it comes to traveling, whether it be by air, train, or auto. Factors such as stress, limited time and space to move around, and medication timing all come into play. So here are a few suggestions and travel tips to consider to make the experience less stressful – after all, stress makes PD symptoms worse, so doing everything you can to reduce stress will be key. The below apply mainly to air travel, but can be extended to long road trips. They are simple and “make sense”, but do not always come to mind when planning travel.

• For those of you traveling by airplane, selecting a non-stop flight is often the best way to go. It reduces your total travel time, and therefore the total amount of time for potential discomfort and stress. However, an exception may be that for some particularly long flights (for example, coast to coast) a stop-over can come in handy by providing a chance to really stretch your legs.
• Speaking of legs, it may also be worth it to pay the extra fees to obtain a seat that offers more space or leg room. While nobody likes to add to the already expensive costs of air travel, in the case of someone with PD, the extra leg room may lead to less rigidity and difficulty getting up. If you have a lot of frequent flyer miles and a long flight, now might be the time to consider an upgrade to business class!
• Good seat selection can be an easy and less expensive way to reduce discomfort. Aisle seats provide a little more stretch space, and easier and quicker access to exit or to the lavatory. For those of you who have urinary urgency as a trouble complaint, selecting a seat close to the lavatory also will make things easier.
• Plan ahead! For those of you who may have significant gait difficulty such as gait freezing, shuffling, and imbalance, it makes sense to pre-arrange for wheelchair or “people mover” carts to get you to the correct gate or terminal on time. This is particularly important for international travel, when transfers between terminals may be needed. Most of these services need to be pre-arranged with your flight carrier at least 48 hours prior to departure.
• Security screening: if you have a particularly difficult time standing in long lines or taking small steps in a small confined areas, it is a good idea to let TSA personnel know of your difficulties before you enter the long security lines. They oftentimes may be able to guide you to special shorter lines. Obtaining a TSA Notification Card or having any other official documentation of your PD (perhaps a letter from your doctor) can help explain your particular situation. The TSA Pre✓® program may be a good idea to enroll in for frequent travelers, as it provides an expedited screening process and takes away the need to remove shoes, belts, light jackets, laptops, and 3-1-1 liquids. For more information, see: tsa.gov/travel/special-procedures
• Deep brain stimulators and Security: for those of you with a DBS system implanted, the general recommendation is to notify TSA officers that you have a medical device (“pacemaker for the brain”, while not entirely accurate, often gets the point across easily) and to obtain a pat –down screening. Carrying your DBS device card will facilitate this. Full body scanners used in many airports these days are not likely to cause trouble with deep brain stimulators, but the technology is relatively new. Metal detectors should be avoided, but fortunately newer generation DBS systems appear to be far more resistant to magnetic fields than the first generation DBS.
• Okay, now you are on the plane! Rigidity is a common complaint for those with PD, and the longer one is stuck in a seated position the more problematic the rigidity can become. So periodically doing some simple heel and leg lifts while seated, and stretching out your arms above your shoulders (watch for your neighbors when doing this!) can help reduce rigidity. If it is feasible, try to walk up and down the aisle a few times every 20-30 minutes (especially for long flights). But of course, watch out for potential tripping hazards such as other passengers’ feet!
• If you are seated for a long period of time, stand up slowly and hold onto the seat; lightheadedness, especially when standing up, is very common in those with PD. For those of you with orthostatic hypotension (drop in blood pressure with position changes), wait 15 to 30 seconds before you start walking down that aisle.
• Stay hydrated. It is too easy to not drink enough fluids while traveling, due to time constraints, concerns about finding a rest room, etc. But drinking enough fluids, especially water, is a good way to avoid feeling lightheaded, fatigued, and constipated.
• Be aware that constipation can become worse with travel. Constipation is already a very common and challenging problem for many PD patients, so things can become even worse. Make sure you get enough natural fibers and fresh fruits and vegetables in your diet during your travel time. For those of you who take supplements or medications for your constipation, don’t forget to bring them with you along with the carbidopa-levodopa.
• Time changes between time zones: this is always a difficult matter to deal with, because there are so many variables involved. They include how many time zones traveled from one’s baseline time zone (especially for long distance international travel), total travel time involved, possible overnight flights , flying to the east or to the west, the time interval between one’s medication doses, the traveler’s sensitivity to ON/OFF times and if he/she has motor fluctuations, and what a traveler will be doing when he/she arrives at the destination. Also, each person’s ability to adjust to a new time zone is different, or may change as he/she ages. There is no easy answer, and perhaps just knowing that medication timing and ON/OFF times may be thrown off a little during the transition periods will allow some peace of mind. It might be a good idea to ask your neurologist for some suggestions on medication timing prior to travel.

Finally, try to keep an open mind and have fun when you travel. Hopefully your travel plans are more so for pleasure rather than business alone. As one of my patients once told me, “I feel so much better when I am on vacation. I sometimes don’t even feel I have Parkinson’s disease!” To which I replied, “That’s great! I wish the insurance companies would cover a prescription for ‘Vacation to The Bahamas!’”