Maintaining Independence: Travel Tips for Parkinson’s Patients and Their Caregivers

[00:00:00] Traveling with Parkinson's does require some preparation, especially around medications, mobility, fatigue and safety. But travel reconnects us with family. It feeds our soul. It reminds us we're still having to fill our life with possibility of excitement. I'm Dr. Sandeep Sikhar and today we're going to make sure that Parkinson's never becomes a reason why we stop going places.

[00:00:39] Welcome back to The Caring Neurologist. Today's episode is to focus on travel related to Parkinson's disease. This episode can apply to many health disorders as well, but we'll dive into this topic of travel and remind ourselves that we still have control over this disease. We want to continue our lives to live despite the diagnosis. One of the first questions that I get from patients after Parkinson's diagnosis is, can I still travel? And my answer is always, yes, that's the right plan, right?

[00:01:08] We want to make sure that we keep motivating and saying, yes, we can travel because travel does matter. It reconnects us with family. It feeds our soul. It reminds us that we're still having to fill our life with possibility of excitement. But traveling with Parkinson's does require some preparation, especially around medications, mobility, fatigue and safety. I'm Dr. Sandeep Sikhar and today we're going to make sure that Parkinson's never becomes a reason why we stop going places. Let's get started.

[00:01:36] Hi, Dr. T. It's nice to see you again and especially talking about something so important that is traveling. Like you mentioned, traveling is good for the soul. It's good to refresh our spirit. So it's really important that patients with Parkinson's do this. Having said that, Dr. Takar, it is one of the biggest fears of people with Parkinson's to lose their independence, including the ability to travel.

[00:02:04] What do you tell your patients when they ask if they can travel? Well, this question, again, has come up numerous times. In fact, this topic today that we're talking about came from the patient specifically and said, hey, do you mind talking about travel on your podcast? And I said, sure. And the reality is the diagnosis may change how you travel, but not whether if you travel. The traveling with the diagnosis is absolutely doable. It's a shift, though, of that spontaneous exploration to that strategic planning.

[00:02:33] The goal is to minimize the stress around travel. There's a lot of fatigue that can happen when you're traveling, even across different time zones. And our goal, again, is to minimize our symptoms regardless where we are. But it can be aggravated sometimes when we're not planning our travel correctly. And we want to have a good experience so that we want to do it again. And a lot of our memories from childhood come from travel with our parents or friends or family.

[00:02:59] And, you know, the aspects of it when you do have a family and you have friends and you have relationships is it's meaningful to have everyone to be on the same page. So travel, again, is very possible with Parkinson's. It's one of the things that, especially during the summer, we get that question a lot. We've had a lot of patients already in this start of the summer who've gone to the East Coast. They've gone to Hawaii. They've gone to Mexico. They've gone to Europe. And we even had some patients who've gone to Africa for a safari.

[00:03:28] And there's many different ways that that can happen. But you have to, again, do your research. The one aspect is Parkinson's does affect each person differently. So our symptoms can seem exacerbated when we're under the stress of traveling, whether it's, again, different time zones. We're not eating right. And so we do need to plan our personal kind of health related issues accordingly because it affects the physical, cognitive and even the emotional aspects if we're getting really fatigued or tired.

[00:03:55] So I do see that with travel, some of the biggest fears people have is how am I going to sleep with different time zones? I'm already not sleeping well at night. What about my fatigue? How does that play a role? How does my GI system play a role when it comes to constipation? And then, again, the aspects of we want to pack in as much when we're already traveling. And we really have to hone in on the importance is that we don't need to overdo everything on travel because sometimes it's just hard to recover.

[00:04:23] And then, again, makes the trip less enjoyable or less pleasurable. So, again, it does take time. So how can people thoughtfully plan their trips? Where should they start? Yeah. So one of the things I would say is we want to consult your neurologist about your trip. You want to especially talk about it when it's an international trip.

[00:04:44] And if there's been any recent health changes like cardiac or respiratory issues, then maybe you want to get clearance from even your primary care doctor. But you want to make sure that you don't travel right after a recent procedure or any major changes in medicines. A lot of my patients, they're going on a trip, but I think some medicines need to be changed. I don't like to incorporate any new medicines to be started. I may adjust timings.

[00:05:09] I may add on some boosters if need be, or I may tell them, let's take some extra levodopa around the time when you're tremoring or stiff or you're feeling like you're having some freezing of gait. But really want to not make big changes of medicines when it affects their sugar levels or blood pressures. And that's, again, something that we don't want to have someone feel like they're getting dizzy or lightheaded when they travel. The other thing that we recommend is maybe get a travel letter from your doctor listing the diagnosis, the medications, whether the generic or brand names. Also having emergency contacts.

[00:05:38] If you're going to a certain place, you want to research the medical facilities in that area, maybe even the emergency room. If you're really concerned about, you know, having had any recent chest pain or shortness breath recently. And again, there's a lot of things that are not Parkinson's specific, but you can have to be mindful that if you've had a recent stroke or heart issues that maybe you want to avoid the travel.

[00:06:02] Or if you are traveling and it's just something that you must do or you want to do, you know, you're just mindful of where the emergency rooms are. Also have a copy of your insurance card. I think that's really important. Some insurance is covered by, again, travel insurance. And you can, you know, pay for that additional travel insurance. But also, just so you know, you guys should look at your credit cards. Sometimes credit cards have the ability to cover medical expenses. And that's, I think, is very unique so that you can avoid paying for any extra insurance.

[00:06:32] Now, plan out aspects of your trip. For instance, if you know that you have good hours of the day where it's easier to walk, your meds work better, then maybe plan some expeditions or walking around that time. So maybe some people feel better mid-morning. But you don't want to necessarily do something too late at night when you're already fatigued. If you're going to a place that's very hot, again, maybe you want to be mindful of taking rest and, you know, planning to have enough adequate hydration.

[00:07:00] So you don't want to overpack your itinerary. That's one of the things that we tell people is build rest time or buffer days. That's really important. Maybe avoid late dinners. And again, the importance of your GI system. I think planning even restaurants, like maybe not having too many carbs and too much meat.

[00:07:18] Again, bringing in still a lot of veggies because your system may feel off when you are traveling and not eating the normal regimen that you typically have to control your GI system. Yeah, traveling does affect your microbiome, right? So being mindful of that is really important for patients to consider. We've seen that, you know, you let loose on vacation. Sometimes people may drink some alcohol more than they're used to. And that could affect, again, your hydration status.

[00:07:47] Maybe it can put you at risk of a little bit more falls. It can make you a little bit more tired. But also one of the things that me and my family do is we eat a lot of desserts on vacation. And we have to be mindful that, again, it does disrupt sleep. But, you know, when you have a lot of sugars, then your body wants to cleanse it and that makes you pee at night. So, again, I've been very picky about how we eat when we go on vacation and avoiding as much extra desserts that's unnecessary.

[00:08:15] Yeah, so it's important to enjoy your vacation. But part of enjoying that vacation is to be balanced so that everything goes as smooth as possible, right? And because traveling does disrupt routines and it's kind of hard to not be a little bit improvised when you're traveling or adventurous. Like that's kind of the spirit of going away.

[00:08:40] So how can patients avoid medication pitfalls while they're traveling? Yeah, so one important reminder, I think missing a dose of levodopa isn't just inconvenient. It can trigger a significant worsening of symptoms. You know, medication management is non-negotiable, in my opinion. You never put your medications in checked luggage, always carry them on. We highly recommend at least getting an extra week of medications. Some people say we've even doubled the supply dose just in case.

[00:09:09] Remember that, again, you're going to have time zone changes potentially. So that may adjust your dosing schedule. So you work with your neurologist to create a schedule that's appropriate. Now, what I tell patients, for instance, and this happens a lot. We're in Southern California. So if we have to go to the East Coast, you know, it may not be hard with three hours ahead. But when you're going to Europe or even going to, you know, Southeast Asia, you know, you're flying in the time of travel along with the disruption of the time zones.

[00:09:38] So what I tell people is on the day of travel, you stick on the same schedule that you are on during that day. And if you are maybe having a flight at night, then you may still may require a dose in the middle of the night just to boost through when it comes to your carbidopa, levodopa. But then when you land in your new country of vacation, then you want to start the schedule on their morning.

[00:10:05] And that's what's really important is like try to get onto their morning schedule. So maybe you are in, you know, California, for instance, and you're flying out at noon and it's going to be a nine hour flight to Europe. So when you land in Europe, it's like in the middle of the night, but then it's morning for them. So you would still start your first dose like it would be in the morning on Europe time once you get there. And then you would separate your dosing accordingly.

[00:10:34] But again, there may be more complex schedules that people take when it comes to their Parkinson's meds. And I think that's really important to talk with the neurologist accordingly. I always try to even tell patients, let's try to get close to that time schedule as you can the week of the of the travel. So even like I start waking up a little bit earlier that week of travel, like every day, like by 30 minutes and then eat the next day, another 30 minutes.

[00:11:00] So that by the time I'm getting used to like an East Coast travel, I'm already on their schedule by Friday. So it makes it easier to adjust. Always keep the medications that you're taking in the original label bottles with your name on there. Also be mindful of temperature sensitivity of some medications. Keep it cool and in a dry spot. If you have pill organizers, you can take them in a smartphone. Alarms are always important to make sure that you're on time with precision.

[00:11:27] And then also, if you have some branded names, again, be mindful of the generic names. I think that's very key. And make sure you have enough refills in case you're running low before your trip. You always want to have enough. And doctors can always kind of renew the medication or extend out the amount that you need for the next time you're picking it up so that you don't run out during the trip. So it's important to take your medication in the new place like you would at home.

[00:11:56] At the same time that you would at home, but translate it into their time zone. Into their time zone once you're there. Yeah, usually it's the second day that typically happens. But on the day of travel, you want to stay on your schedule. And then there are times where patients may take an extra dose during the nighttime because maybe they're ready to wake up or they're, you know, sleeping. But they just need a little extra levodopa to give them a boost. And so you talk with your neurologist about what's that appropriate extra dose to get you going.

[00:12:25] But a lot of our patients, again, they'll need something in a timely fashion. But we don't want it too close together and keep it always spread out appropriately. And that's a conversation to have with your neurologist. Definitely. And airports are overwhelming for everybody, but they do present specific challenges for Parkinson's patients. So what practical tips do you have for navigating air travel?

[00:12:50] Yeah, for caregivers especially, I want to say that you want to advocate early and loudly at the airport. Airline staff want to help, but only if they know what you need. So airports are designed for distance, not ease. The stress of rushing through the gate, you know, can trigger a lot of physical symptoms. I always tell people is actually look up TSA CARES. It's an actual program, TSA CARES. So you request TSA CARES.

[00:13:15] And in the U.S., you can contact a TSA CARES agent at least 72 hours before flying. And if you are traveling, I highly recommend looking them up and getting ahead of it. And even if you're not traveling, just know that they exist. But they provide a dedicated officer to guide you through the security checkpoints with minimal hassle. They help you with kind of understanding your medications and what needs to be checked or what doesn't. They can book wheelchair assistance early for you as well.

[00:13:44] But that's something you should also consider by either calling the airlines or if you have a travel agent that can always help. Even if you walk fine at home, airports, especially at the terminals, they can require a lot of walking. And it's a lot of hustle and bustle. You may want to, again, book the wheelchair or airport cart to ensure you can conserve your energy so that you can actually enjoy what you need while you're on vacation. Get priority boarding if you can.

[00:14:13] Ask to board early if you have plenty so you can get plenty of time to get settled in your seat without the pressure of everyone, you know, crowding in behind you. And always take advantage of getting in early if they allow for that prior to boarding. The TSA and security, you know, you want to inform the agents about your condition, especially if you have a deep brain stimulator or any device, metal implants. It could trigger the alarms. I always tell people, do the pat down, take your, you may have a device card for your DBS.

[00:14:42] If you have a Duopa pump or a Violev pump or a Napco pump, you know, you just carry that with you, show them. And then they'll just, they'll check for it, especially if it's on. A lot of my patients may not want to even have the pumps on at that time. And they'll just take their oral medications and they'll have the, their pumps in a carrying case and they'll show it to the TSA agent. The other thing would be carry any documentation for your implanted devices.

[00:15:07] Like I said, comes with usually different cards, uh, plan ahead while you're, um, before you get onto the plane or cruise. And that's again, for instance, you want to have like an aisle seat. You want to get easier boarding. You want to deplane easier. Uh, it allows for better bathroom access. And movement around, uh, along the flight, right? It's important. Like walk the aisles a little bit. Uh, you know, make sure you do, uh, stretching while you're on the seats.

[00:15:35] Make sure you can manage that stiffness, whether it's also the neck, right? If you just want to get your shoulder exercise, get your arms, get your legs. I mean, a lot of twisting and turning to keep your body moving. Sometimes there's a feeling of restlessness. If we're not actually moving while we're on a plane or in a seated position for a long time. Um, cruise ships and trains are typically lower stress, uh, alternatives to flying. And I think again, if you were to take a cruise ship and you do have some balance issues, take a walker. Always have that just in case.

[00:16:05] If you're on a plane, maybe have a cane just in case. And you want to, again, also even think about once you're, uh, at the airport about transportation. Again, uh, ride shares, making sure you have accessible ground transportation to a destination. You need to have that already set up ahead of time. And then you want to also think about your hotel and Airbnb and all of that set up for accessibility. Yeah. Um, air traveling is high contrast.

[00:16:32] You know, you're underestimating how far gates can be. Like you actually walk very long distances within the airport. And if you're in a rush, let's say you're, you didn't get to the airport with enough time. That's also added stress because you need to get to your gate faster. And there's a lot of people. So I can see how TSA care. It's called TSA cares. Yeah. C A R E S TSA cares.

[00:17:00] And I would also, I think you make a valid point. One of the, uh, situations is, you know, if you can get a direct flight, that's awesome. If you can't, and you have to connect through, make sure there's enough time in that connecting. I have some patients also, they don't want to do a direct flight. It's too long for them. Maybe if they're going internationally, I don't feel like they can go 12 hours, 13 hours in a flight. So I have some people, what they do is they break up their trip. So they'll be in like say California and they'll fly to New York for five or six hour flight.

[00:17:29] Take a break there. Rest. Maybe go to a hotel, be at a hotel at the airport. Relax, get comfortable. And then the next day they've scheduled their next part of their flight to go to Europe if they needed to. So you can also break up your trips accordingly. Yeah. I was going to say that's a good idea because you go from running and getting to the gates in the airport and then being static for hours. I can see how both are stressful for the body and the mind.

[00:17:57] And on that note, not all destinations are created equal. For someone managing Parkinson's, what should patients consider when choosing where to go? And what accessibility features matter the most? Well, the world is more accessible than it's ever been. Your job is to match your destination to where you are right now physically, mentally, not where you were five years ago.

[00:18:21] So you want to choose destinations with good infrastructure, elevators, flat terrains, accessible transportation. If it is that way, avoid cobblestones. If you have balance issues. I mean, my family and I last summer went to Scotland and the UK area and there's cobblestones and uneven surfaces. Even myself, which I think I have decent balance. You know, you can easily trip or feel in state. And I've hit some uneven surfaces. So you have to be really careful, especially in crowded markets.

[00:18:51] And these environments do put one at risk for high risk of falling. You know, if you're going on a trip, maybe you want to think about like, is it worthwhile to go hiking in Machu Picchu? Where it may not be ideal if you have a balance issue. You know, you want to go and think about maybe if you are in a safari, you may want to consider about accessible jeeps and vans. And one of my patients had just the most amazing time. She has very significant difficulty with walking.

[00:19:19] She's predominantly now in a motorized wheelchair to get around because her legs give way. She had back issues on top of her Parkinson's. So she has weakness in her legs from her back surgeries. But she actually found a really good agency that helped her. And they had tours for those that needed, wanted to still do safaris in Africa. And they had a special type of Jeep that allowed for her motorized wheelchair to get on and strap safely. And so you can do your research.

[00:19:48] You can go to places that you never thought you could. So it's really about understanding what your limitations are. Researching in the hotels, accessibility is the roll in showers, grab bars, proximity to dining. If you're not able to walk long distances. You know, cruise travel, again, it becomes such an excellent option for a lot of people. Easy for unpacking, you know, accessible decks, the medical staff that's on board. You know, you may want to think about national parks, museums with scooters and wheelchair rentals.

[00:20:17] So you don't want to exclude yourself from such experiences. And there are Parkinson's friendly travel agencies and tour operators that exist. So I did my own search and I've looked into this. So for some of our patients, we recommend elite cruises and vacations. There's also another company called Travel for All. There's another company called Accessible Journeys.

[00:20:40] So I would just look into different agencies that are amenable to where you want to go. And some of these agencies that I looked up, like they're good for Europe. They're good for Africa. They're good for even North America in, let's say, Canada. And even Mexico, they have different specific agencies. So I would even look at like those that have translators in case. So you can, if there's Spanish speaking or English speaking and whatever is comfortable for you.

[00:21:08] But as you pick places to travel, remember, sleep is extremely essential. You may even want to pick a hotel that has, you know, like a good bed or comfortable bed, something that you're used to, or even at some hotels that have gotten really unique that they have a pillow menu. So again, I think that the world is your oyster, but you just got to do your research for it to make sure it's still very comfortable. Because as we know with Parkinson's, sleep gets very uncomfortable.

[00:21:33] We may have problems with sleep and we want to really bring in, you know, that transition of quality sleep when you are traveling elsewhere. Dr. Tien, maybe we can link those agencies that you mentioned in the show's notes so that people have access to those resources or at least the names that they wanted to look into that. And what happens when symptoms worsen mid-trip?

[00:21:58] How should patients and caregivers respond if there is a sudden motor fluctuation, a fall, or an off episode while they're away from home? Yeah, so the preparation doesn't eliminate the risk, but it transforms a frightening moment into a manageable one. I've had patients, you know, talk about their trips and something happened where they fell, they've tripped on, you know, or they missed a step. So you don't want to have like a broken foot, but these incidences could happen.

[00:22:26] I had patients slip on areas where, again, it was a wet surface. So having an emergency plan is always key. You always want to be able to improvise. And I think that's why, again, having your insurance card is so key. But know the signs of your off time. But it's not just about you. The people you're traveling with, they should understand your symptoms and you should be very thorough with them about what you've been experiencing, what's been going on recently. And they should also know what your symptoms are when it comes to tremor or fatigue as opposed to someone who, you know, like could get a stroke.

[00:22:55] And so, unfortunately, life happens and we can still get a stroke or a heart attack. And if you're having fatigue and difficulty walking, but you're feeling now respiratory issues or chest discomfort or pain going down the back, these may be different from your typical PD symptoms. And make sure that you're clarifying to family or friends who you're with that this is different. Now, falls especially, you want to be working on safety, how to get up quickly, how to call for help.

[00:23:22] You know, some of our patients, that's when they wear their Apple watches or any other devices that can alert friends or family. Some of our patients have medical ID bracelets with them or medical ID cards that have their diagnosis or medication. So, again, having the medication list on you could also help if paramedics are there at the scene to take you to the local hospital. Now, when you are traveling, talk to your neurologist because some neurologists, especially like us, we have telehealth services.

[00:23:51] And so, we will, you know, get on the telehealth if need be so we can do a virtual call to kind of figure out what's going on in that, you know, mid-trip and see what we can do to help people. But having quiet days are very important. Have a protocol where it's built into a trip that you may require a quiet day or a relaxed day so that if symptoms are flaring up, you're ready to recover. And rest is truly one of the best medicines. And that's the whole purpose of this vacation is that you're actually getting to enjoy and hopefully get some rest.

[00:24:21] But we want to, again, make sure that a trip is not overextending one's energy and causing worsening fatigue. And Dr. T, would you recommend for them to schedule a telehealth consultation prior to leaving so they know that in the middle of their trip, they're just going to kind of check in with their neurologist and see how they're doing? I think that's a good idea. We've not actually incorporated that.

[00:24:49] Usually, patients do quite well in their vacations. They've planned ahead. But again, if there's ever a concern, like I have a patient who lives part-time in Mexico and then they're half-time in the U.S. And they had a stroke. And they called me up and they said, hey, I need to get on the call. I'm in the hospital. So we had a telehealth visit. And even though they're not on vacation, they were just away from us. But at the same time, you know, they wanted our opinion on things. So we were able to give them our two cents about what needed to be done.

[00:25:17] They already had a neurologist that was there to work with them about their stroke. And we were able to communicate what needed to be done. But then once they came, when they were out of the hospital, then we had set up another appointment through telehealth and then also had them come see us. And they actually, you know, again, fortunately, didn't have any long-term complications of the stroke. So, again, maybe planning for a quick follow-up once they're back is fine. That's good to know. That's always, I guess, a peace of mind for patients.

[00:25:47] And so we know that Parkinson's patients want to keep their independence. That is kind of the topic of this conversation. And traveling is one of those aspects of independence. So is solo travel possible? Can they travel alone? Or is it always necessary to be with someone, a caregiver? And if they're traveling with a caregiver, how do they make that partnership work?

[00:26:14] So patients can travel by themselves if they're able to. I mean, if they're independent, they're working. If they're not working, but they're, you know, able to get around and do their daily activities, like going to a store or going to a bank, you know, cooking. Then, you know, you can still travel by yourself. But if you are wanting to do a trip with family or friends or you have a caregiver, then it's okay to have a trip with others. So my thought process, again, is for caregivers, you're not just there to be a helper for this trip.

[00:26:44] You're also there for your own travel. You want to make sure you're a companion, but you want to make room for joy for each person. So solo travel, though, is possible. And again, that's seen a lot more with my patients with early stages. You know, you're still careful what you're planning. You do everything that we've kind of talked about when it comes about, like the hotels and planning where you want to go eat and taking breaks. So you inform your hotel about your condition if you have, you know, concerns about solo travel.

[00:27:13] But I think that, you know, that's not something you have to do. That's only if there's concerns about falls and making sure that, you know, if there were some bouts of dizziness or lightheadedness, like some food sickness issues that you let the hotel staff know if you're alone. That, hey, I need to, you know, get a doctor on call. And that's the other thing about other countries is they do have doctors on call that actually come to you. And that's another important aspect to do research on if that's available in that country.

[00:27:42] So share your itinerary if you are alone with other people so that people can check in and vice versa. You know, if you are traveling with a caregiver, again, set clear roles and expectations of the trip and what you guys want to accomplish. You know, if the caregiver is there with you, they also need rest. So it's also important for their well-being, respect each person's patience and caregiver's dignity. I think that's the most important thing. Be there, though, for safety.

[00:28:09] I think having a caregiver is to reduce the risk of falls and make sure that we're on time with medications. I think group tours are probably the best with people with any medical disabilities or chronic illnesses. And that's where even with these group tours, like food is prepared. It makes they have like lunch snacks and things like that. So you don't have to necessarily go off the beaten road and beaten path to find places to eat. So it does make it easier when you're doing such group travel and tours.

[00:28:36] It reduces a level of stress and decision making. Right. Although I guess for some people it might be more stressful. Yeah. You know, again, you just have to know what type of person you are and how you travel. But, you know, maybe in certain aspects of your life, you're like, you know what? I could make decisions. It's the fun part about traveling is pre-planning and doing things or, you know, being courageous and trying new places. But, you know, if you really if you have Parkinson's and you're concerned about risk of falls and just your general health,

[00:29:03] and it's going to be a struggle in some aspects with fatiguing, a lot of walking, then, you know, make the trip more fun and relaxing without trying to overextend yourself. And technology has changed travel for everyone. But are there specific apps, devices or tools that can make a meaningful difference for Parkinson's patients on the road? Again, I would say that, you know, any of these smartphones now, they're just amazing.

[00:29:29] The smartphones in your pocket can probably be the most powerful travel companion. So use it. Make sure you have enough battery. You know, we use our phones a lot. We're taking pictures. We're doing videos. We use the Google Maps, Apple Maps, whatever it may be. And so we may drain through our battery. So, again, we even have all your accessory, you know, power adapters that you may need. But medication reminder apps are really good. There's something called MediSafe. There's MyTherapy. There's other simple smartphone alarms that are there.

[00:29:58] But the GPS navigation apps really reduce the stress of finding your way around. Make sure you have your itinerary even on your calendar of your phone. You can have wearable devices that track your gait. There's devices that may track your tremor and activity level. And I think Garmin has some really good wearables also to tell you that you're getting fatigued or you're tired or you're under stress. So it's actually unique that all these devices exist.

[00:30:25] I think the Oura Ring has some very unique information for patients themselves. So something that you could think about. I'm not asking you to necessarily buy all this different technology, but it does exist. And when I've traveled to other countries that I used like a Google translator, the translator apps that exist are really good for communication, especially for medical needs.

[00:30:48] And even if you were to practice certain, I would say, sentences so that in case you're like wanting to communicate with someone, you can't pull up your phone. Maybe even have that already listed on like in your wallets about how to speak about like, hey, you know, I have Parkinson's and I need to see a doctor. Is there an emergency room or I need help because my legs are weak? And, you know, you just have very basic sentences.

[00:31:14] Even if you're lost, you know, I think that's so key to have even the phone to help communicate, you know, between different languages. So the last part I think of technology that I think of is maybe you have on your phone like a telehealth app for quick video calls if you needed to. And of course, you know, know how to use your phone when it comes to the emergency SOS features, because those can help trigger a local ambulance or 911.

[00:31:44] So two things that come up is have an external battery. I think that's a great tip. Then you make sure that your phone is never dead. And the other thing that you mentioned about learning a few sentences for emergency cases, maybe have those written down in your wallet as well. So you can show the paper to the person you were asking for help. I'm guessing sometimes it's it's hard to remember a new language, right?

[00:32:10] So in case you don't remember, then you have a paper there that somebody else can read. And Dr. Takara, we've reached the end of our episode, but beyond the logistics, there's an emotional dimension to traveling. So for patients who feel like Parkinson's has taken much from them already, what would you say about why traveling still matters? And what does it mean when patients say, I went, I did it? Yeah. You know, Parkinson's changes your itinerary.

[00:32:40] It doesn't cancel your life. And earlier this week, actually a patient of mine, she went to Paris. She traveled by herself. She said that she had to, she just had to. And I agree with her. Like, you know, it makes sense. And I was just shocked. She's like, yeah, I just, I wanted to get away. And I was thinking like, she went to get away for a week. And she's like, no, I went away for a week. I went to Paris. I'm like, oh, good for you. I was like, who did you go with? She's like, no, I went by myself. She's like, I told my husband, I told my daughter, I'm just going to go.

[00:33:09] I need a break from life, from work. And, you know, my first thought process is like, is she okay? Is she depressed? Is there any suicidal thoughts? What's going on? Why is such a dramatic change? She's like, no, you know what? I've always wanted to get away to Paris. I've always wanted to vacation. And it's just been on my mind and things have just gotten overloaded. And I just thought, you know what? If I'm not going to do this now, I'm not going to do it. So she went and she relaxed at cafes. She saw a few museums. She shopped around.

[00:33:37] She said she did some window shopping and she just needed to get a refresh and decompress. And again, she's like, I did it. And I, throughout our conversation, I was like, just remember that you did it. Like you can accomplish a lot of things. And I had to keep giving her affirmation about it because it's really important. It is the psychology and emotional aspects about travel that we are, you know, bigger than our challenges. We can overcome those mountains.

[00:34:04] And again, the purpose of vacation is to still be you. Again, there's something exciting about seeing a new culture, experiencing new foods, and that's living. So I always tell patients that, you know, you want to connect with your past time, see family, see friends. And sometimes again, family and friends are far away. Like, so don't let, you know, managing an illness limit you.

[00:34:32] And there's a saying that is said, it's called YOLO. You only live once. And I do not like that at all. I don't think it's true. I don't think you only live once. One of the things I want to tell people is, and I changed the reference of it, is you actually only die once, but you live every day. And it's so important to live every day. And it doesn't mean that like every day you have to be on vacation, but, you know, be mindful

[00:34:56] that each day is a gift and you don't have to necessarily travel to another continent. You know, there are people who have difficulty with even thinking and grasping about travel. And I tell them, you know, if it's been a long time that you haven't traveled, then maybe that's also a burden for your partner and your partner wants to travel. So maybe start with small things, smart, start with maybe, you know, like a staycation,

[00:35:24] maybe a hotel near the beach or a hotel near the mountains, maybe just only go an hour, two hours away. Maybe you want to do an RV travel. And so there's different things that one can accommodate too. And there are a lot of people who just even recently I've had patients who were supposed to travel the last few months to see their grandchildren's graduation. And also attend weddings. And some of them went and some of them couldn't make it.

[00:35:50] And so those that couldn't make it, we told them, okay, we'll make a video, express your feelings and congratulate, you know, your family for their, you know, whether it's for the wedding or for their graduation and express the joy that you wanted to be there. But say, you know what, we'll plan another time. And when, and then we'll just try to make those accommodating features. But sometimes things happen and people want to travel on right, like the next day. And it's maybe not realistic. So it's very important to plan ahead.

[00:36:19] And, you know, one step at a time is really, really important to plan without overextending yourself. Well, thank you for everything that you've shared today, Dr. Takara. I think this is very inspiring for those who have had the urge to travel and have felt like maybe they're limited to do so. Now they have a little bit more information and a few resources to look into and to have

[00:36:43] the travel accommodate to their lifestyle and not have to feel like they need to change or they need to be somebody else to be able to enjoy the beauty of traveling. And like you mentioned, fully living. Exactly. One comment about the resources, you know, even AAA, AAA has some really good resources and you can go on their website and AAA also has services that maybe you can even go into. But again, look into like a travel agent and, you know, don't just limit yourself to like

[00:37:13] your Google searches. You know, even Rick Steves has a good website that you can look online about travel with, you know, with health issues. And there's a lot of booklets that are out there. Traveling with Parkinson's isn't about ignoring your diagnosis. It's about refusing to let it become your only destination. Whether it's a weekend with family, a cruise with a caregiver, or a dream trip you've been putting off. Dr. Takara's message today is clear.

[00:37:40] Plan carefully, travel boldly, and never stop moving forward. If today's episode inspired you, please share it with someone who needs to hear it. A newly diagnosed patient, a caregiver, or a family member who's wondering what comes next. Because the world is still out there and so are you. Thank you for listening to The Caring Neurologist. The Caring Neurologist.