“You have atrial fibrillation,” says the doctor.
These are not the four words my husband, Terry wants to hear from his cardiologist a few days before we are scheduled to leave the country for a cruise from Southampton, England to the remote Norway fjords on the ultra-luxurious Queen Victoria ocean liner. We’ve been looking forward to this trip aboard Cunard’s posh new ship for months. Our bags are packed. We’ve canceled the newspaper and left our itinerary with the family. The timing couldn’t be worse. But is there ever a convenient moment for negative health surprises?
According to the American Heart Association, atrial fibrillation is found in about 2.2 million Americans. The likelihood of developing this condition increases with age — three to five percent of people 65 or older have it. It occurs when the heart’s two small upper chambers (the atria) quiver instead of beating effectively. Because blood isn’t pumped completely out of them, it could pool and clot. If a blood clot in the atria leaves the heart and lodges in an artery in the brain, a stroke results. About 15 percent of strokes occur in people with atrial fibrillation. This is not something we wish to ignore.
The doctor outlines the treatment. For starters, Terry begins a daily regimen of Coumadin (or Warfarin), an anticoagulant that decreases normal clotting time. We have trouble mustering enthusiasm for a drug that is used as rat poison but the doctor assures us that when monitored via a weekly blood test, the drug is considered safe. Once consistent blood levels are achieved, a cardioversion (an electric shock to the heart) will be performed in the hospital and Terry’s abnormal heart rhythm should revert to normal.
Before we leave the doctor’s office Terry gets more bad news: no alcohol. Usually healthy foods that are high in vitamin K such as Popeye portions of spinach and other green leafy veggies, broccoli and cauliflower are no-nos. As a sign of solidarity (and empathy) I vow to resist my beloved Cabernet and teetotal with him.
But what about our trip?
Many of our retired friends avoid international travel because of concerns about the “what ifs” that might happen while in a foreign country. What if I fall? What if I have a heart attack? Or, like Terry, what if I need my blood checked? Terry and I love worldly adventures and don’t plan to give them up because of our advancing ages. Instead, we’re traveling smarter. A quality cruise ship is our answer.
Shortly after we board the Queen Victoria in Southampton, Cunard’s snazzy luxury liner, we meet with Dr. Jacques Badenhorst in the ship’s state-of-the-art medical center, an ISO 9000-certified facility. (ISO is a stringent, globally recognized standard for evaluating medical facilities.) “Some hospitals still try to achieve this standard,” he says proudly. The onboard medical team includes two doctors, three nurses and a medical technician.
The medical center on the Queen Victoria includes a fully equipped Intensive Care Unit plus a seven bed hospital, a fully equipped lab that provides immediate blood test results for heart enzymes, strep, flu, hepatitis and sophisticated equipment to instantly check Terry’s INR blood level.
A ventilator, oxygen and two defibrillators are onboard (a nurse carries one with her at all times). Even temporary dental work can be done if a crown loosens or a filling falls out. If someone breaks a bone, x-rays are taken and e-mailed to a stateside hospital for a consultation. Leave your medication at home? The medical center stocks the basics. For drugs not on board, a protocol is in place: a message is radioed to the agent at the next port. When the ship arrives, a filled prescription is waiting.
The onboard response time for heart attacks and other emergencies is under 5 minutes, day or night. And, while rare, patients can even be airlifted from the ship.
Dr. Badenhorst offers some advice for Americans traveling anywhere else in the world: “Travel with a complete medical history or letter from your doctor detailing any pre-existing conditions and medications. And, be sure to get medical travel insurance before you leave.” If someone needs to be taken to a hospital in a foreign port, he says, some hospitals will accept cash only.
Terry’s INR blood test reveals that his level is too low. Dr. Badenhorst adjusts the dosage of Coumadin. Once Terry’s medication is adjusted, we explore the ships more entertaining amenities. Having fun and creating happy lives is part of our personal wellness regimen.
According to a recent study, Harvard researchers confirmed what we believe intuitively. People leading happier lives have healthier hearts — they have fewer sticky platelets. That means the blood cells in happy people are less likely to form fatal clots in the bloodstream. We take our “medicine” willingly as we check out the ship’s features — a three-story Grand Lobby, finished in fine mahogany, marble, intricate mosaics and a swirling ornate wrought iron staircase; an elegant 800-seat theater with private boxes and a two-storey library (the first of its kind at sea) with 6,000 books. We bypass solitude and cozying up with a good read in favor of the bright conservatory, a massive space with a retractable glass roof and glass wall that open to reveal a sizeable swimming pool.
Heart-healthy exercising isn’t a problem. Terry enjoys the well-equipped gym while I take a fencing class. We use the stairs instead of the elevators, a significant cardio workout up and down the ship’s 11 decks. Evenings offer a more romantic way to stay in shape–a big band plays our favorites in the chandeliered Queens Ballroom. We tango, foxtrot or rumba around an inlaid dance floor that’s fit for Fred and Ginger.
While we would love a martini (or two), life without alcohol is easy thanks to non-alcoholic beer and several luscious mock cocktail choices. Healthy dining isn’t a problem either. In fact, we feel like we are traveling with a personal chef. Every dietary request we make in the stylish Princess Grill receives a two word response: no problem. No snooty attitude or eye-rolling when I ask that the olive tapenade from the sea bass top my halibut in lieu of a cholesterol-packed cream sauce. Since the Todd English restaurant (the fanciest one onboard) offers heart-healthy Mediterranean cuisine, we savor a five-star meal that would get a thumbs up from the cardiologist.
Because atrial fibrillation can cause tiredness, the sitting area and private balcony in our spacious suite, is a perfect oasis between active port stops. And, since our hotel room moves with us from port to port, the hassle (and exhaustion) of packing and unpacking is a non-issue.
Each day we leisurely explore Stavanger, Aalesund, Bergen and Geiranger, remote towns in the Norway fjords dotted with towering snow-topped mountains, dramatic waterfalls, medieval villages, open-air fish markets and farms accessible only by boat. Each night while the Queen Victoria makes way for our next destination, we rest easy knowing that emergency help, day or night, is as close as tapping the top button on our phone.
Now that we are back home in Annapolis. Terry will have his cardioversion in a few weeks. And, we are researching our next Cunard cruise. We’re thinking, the Greek Islands. Or, maybe, Croatia.
Important things to consider when shopping for travel medical insurance
With few exceptions in parts of Canada and Mexico and U.S. territories such as Puerto Rico, the US Virgin islands, Medicare provides no medical coverage outside of the United States.
While some Medigap policies may cover a portion of medical costs outside the U.S. they may not cover everything. And, if you rely on a Medigap policy when traveling, you may have to pay the entire hospital bill up front and wait for reimbursement. If you need to be evacuated, some Medigap companies may not arrange the actual evacuation or monitor your medical condition.
The cost of most medical travel insurance policies is based on the length or cost of the trip and your age. Travel Insured (www.travelinsured.com) or Travel Guard (www.travelguard.com) are two of the largest travel insurance providers. Helpful web sites such as www.squaremouth.com compare the pros and cons of several companies. Each policy can have its own quirks — some don’t cover pre-existing conditions — so read the fine print carefully. A friend took out a policy that looked like a good deal before she traveled to small towns in Turkey. One middle-of-the-night slip in the bathroom resulted in severe injuries to her face and back. She couldn’t reach the insurance company from the Turkish hospital that was demanding $800 in cash before they’d let her out the door. Since she wasn’t carrying that much money, she and her fellow travelers pooled their cash for her release.
Travel Guard recommends purchasing travel insurance within 14 days of making your initial trip deposit. Doing so will cover situations that may result from a pre existing condition. “You can’t predict what can happen. A good policy is like having a guardian angel with you every step of the way,” says Carol Mueller, company spokesperson.
The number one claim to travel insurance companies is trip cancellation due to a medical problem pre-departure. If you become sick or injured before you leave town this insurance covers the trip deposit.
Medical travel insurance can also cover pricey medical evacuations from cruise ships. An evacuation can cost $50,000 or more depending on your location. A complex procedure, it requires coordination with the Coast Guard, the ship and shore-side hospital. An experienced medical travel insurance provider can coordinate the details.
When traveling to foreign destinations, some travel experts recommend keeping a sizeable available-funds balance on your credit cards. You never know. It might come in handy when tapping into an ATM machine for cash to cover unexpected medical bills.
Bon Voyage!
