We have put together some practical advice guides for some of the most common issues and concerns affecting people with secondary breast cancer:
FINANCIAL SUPPORT FOR PEOPLE WITH CANCER
Work & cancer
Once you have been diagnosed with cancer you are deemed to have a disability and are covered by the Equality Act 2010 (or the Disability Discrimination Act if you live in Northern Ireland). Both acts are there to protect the employee from discrimination and employers are expected to make reasonable adjustments to support the employee. It helps to tell your employer about your condition as not doing so can cause problems and the employer is not required by law to make any adjustments for you at work. Examples of reasonable adjustments include:
- Allowing employees to take time off for attending medical appointments
- Allowing extra breaks to help the employee cope with fatigue
- Allowing flexibility in working hours
- Allowing a phased return to work after extended sick leave
Working during treatment
Deciding to work during your treatment is a personal decision based on your circumstances. Working during treatment can give people satisfaction and helps to focus on something other than the cancer. To help you decide if it is possible to carry on working you should take the following into account:
- Can I get extra financial assistance to help me and my family through my period of treatment?
- Is it safe for me and for others if you carry on working, ie, due to risk of infection. This can depend on what treatment you are receiving and the type of cancer that you have?
- Can I reduce my hours to fit in rest periods when necessary?
It may be best to talk to your employer as they may be able to offer suggestions to enable you to carry on working (see reasonable adjustments)
If you decide that you cannot continue to work you must make sure that you honour your terms and conditions of employment. For the first seven days of your sickness you can fill in a self-certificate available from your employer or doctor’s surgery. Anything over seven days means you will require a certificate signed by your doctor. You may also have to attend sickness review meetings to receive progress on your sickness. By law you should be provided with Statutory Sick Pay (SSP) and this can depend on your employer and this is paid for 28 weeks. You may also be entitled to Occupational Sick Pay if it is stated in your contract of employment, which is paid by your employer. The employer will have certain conditions, for instance, you may get full pay for 6 months and then half pay for another 6 months.
If you are not entitled to SSP or it has run out, your employer must provide you with an SSP1 which outlines why you are no longer eligible for it. You may be entitled to Employment and Support Allowance (ESA) from the Department of Work and Pensions. There is more information on ESA in the Benefits section. If you decide to carry on working around your treatment and you reduce your hours, you may also be entitled to Working Tax Credit if you are on a low income providing you work more than 16 hours per week and you get one of the following benefits:
- Incapacity benefit
- Disability Living Allowance
- Personal Independence Payment
- Attendance Allowance
See further information on Benefits below. For more information on working tax credit please contact the Inland Revenue and Customs department or contact the Tax Credit Helpline on 0345 300 3900.
When returning back to work, another medical certificate will be required to state that you are now fit for work and the doctor may suggest the following for your return to help you settle in again especially after a long term of sickness.
- A change to working hours
- A change in duties
- A phased return
- Adaptations to your working environment
Personal Independence Payment (PIP)
The Personal Independence Payment replaced Disability Living Allowance (DLA) in 2013 in England, Scotland and Wales (people in Northern Ireland are still entitled to apply for DLA) and is available to anyone aged between 16 and 64 who has a long-term condition or disability – whether they are in work or not. Applicants must have a disability or long term health condition that limits their ability to carry out certain activities, and the benefit is designed to cover:
- Daily living activities such as preparing food and communication
- Mobility Activities such as planning journeys or moving around
To be eligible you need to fulfil some required conditions. The qualifying period is three months before the date on which you became entitled to PIP and you must be likely to continue to meet the conditions for at least nine months after the date you became eligible for PIP.
For terminally ill patients, the above conditions do not apply and you are automatically entitled to the benefit.
To claim you need to apply at gov.uk who will send you out a form which needs to be filled in and sent back to them. In some cases you can use a DS1500 which your consultant can complete and send back to them. However you apply, you may need an assessment by a professional health care worker who will assess you based on the information that you stated on your application form.
There are two rates of payment – standard and enhanced. If the DWP decision maker decides that your ability to carry out the mobility activities are limited, you will get the standard rate. If your ability is severely limited, you will get the enhanced rate mobility component.
For more information please see the Citizens Advice Bureau.
Attendance Allowance (AA)
Attendance Allowance is a benefit for severely disabled people aged 65 or over who need help with personal care. AA is not means-tested and it is tax-free. It is awarded either as an ongoing benefit or for a fixed period, determined by the Department for Work and Pensions (DWP).
Attendance Allowance is paid at 2 rates, higher and lower rates but there are special rules for someone who is terminally ill which means that the claimant will automatically qualify for AA at the higher rate. If you make a claim for Attendance Allowance under these special rules, the claim is prioritised and will normally be decided within 8 working days.
Someone is regarded as terminally ill if they have a progressive disease and their death from that disease is reasonably expected within six months. Although there must be a reasonable expectation that death will occur within six months, Attendance Allowance will normally continue to be paid for three years under the special rules. At the end of this time, the claimant may be asked for further information about their health so that their entitlement can be reassessed.
If you are entitled to make a claim under the special rules, your doctor or consultant will be able to help with your application. They will need to complete a DS1500 form and provide information about your diagnosis and treatment. The DS1500 form should be sent with the Attendance Allowance claim form to the DWP. Claim forms are available online, at any Jobcentre Plus office or by ringing the Attendance Allowance helpline on 0345 605 6055.
For more information, please go to gov.uk
Employment & Support Allowance
ESA is for people who cannot work due to sickness or disability and are not getting Statutory Sick Pay. There are two types of ESA:
- Contributory ESA is payable if you’ve paid enough National Insurance contributions in a set period.
- Income-related ESA is a top-up benefit that can be paid on top of contributory ESA, or if your income is too low. The amount of capital you have may affect the amount of income-related ESA you receive
To apply for Employment & Support Allowance, telephone Job Centre Plus who will go through some questions with you and then send you a statement of your situation to check. The telephone number is 0800 055 6688. Alternatively you can download or complete a claim form online at gov.uk. There is also a Welsh Language help line on 0800 012 1888. For more information see visit the Citizens Advice website
Disability Living Allowance (DLA)
You cannot make a new claim for DLA in England, Scotland or Wales but can apply in Northern Ireland. DLA is for people under 65 who are disabled. To be eligible for the benefit, you must have personal care needs or difficulty with walking because of either a physical or mental disability.
The benefit has two parts, the care component and the mobility component. The care component has three rates depending on how often and how much care you need. The mobility component is paid at two rates, depending on how much difficulty you have with walking. You may get one component of DLA or both. You can claim DLA if you claim before you are 65 and you have care needs or mobility needs for at least 3 months and are likely to have these needs for at least another 6 months.
If you live in Northern Ireland, you can apply by phoning the Disability and Carers Service on 028 9090 6182 Helpline or apply online at nidirect.gov.uk
For further details and the current rates, please visit nidirect.gov.uk
Macmillan Grant – A one off grant for people with cancer who have low income and savings. You can apply for a grant for things such as clothing, travel to and from hospital, telephone installation and bills, heating and holidays. To qualify for a grant, you must have cancer or still be affected by your illness or treatment and fulfil the following criteria:
- Have no more than £6,000 in savings if you are single and £8,000 as a couple or family
- Have less than £170 per week disposable income if you are single or £289 per week for a couple, plus £85 per child or £119 for each additional adult in the household if their income is relevant
To apply for a grant you will need to contact Macmillan who will send you out an application form and offer further information. For more information please contact Macmillan by telephoning 0207 840 7840 or by going to their website macmillan.org.uk
Charis Grants Ltd – Charis manages trust funds and local assistance funds on behalf of some of the major utility companies and local authorities. The aim of the trust is to provide financial assistance for people who are in debt or have difficulty paying their bills. The grants are available to:
- Clear debt for your gas, electricity and water bills
- Cover bankruptcy
- Buy essential household items such as energy efficient white goods which includes washing machines
For more information, please contact Charis by telephoning 01733 421 021 or go to charisgrants.com
Prescriptions are free in Scotland, Wales and Northern Ireland. People with cancer in England are also entitled to free prescriptions. To apply you need to get a FP92A form from your doctor or oncologist. The exemption certificate lasts for 5 years and excludes you from paying prescription charges, which can be especially beneficial if you have lots of medication prescribed.
Road tax exemption (free tax disc)
You may be entitled to a free tax disc if you are disabled and get the higher rate of the mobility component of DLA or the enhanced rate of PIP. If you get the standard rate of PIP you may be entitled to 50% discount on the cost of your tax.
London congestion charge
There is a charge to travel within the congestion charging zone in Central London at certain times. If you have a blue badge you can register for a 100% discount so you will not have to pay. However, there is a one off payment of £10.
Hospital car parking varies around England, many hospital have concessions for cancer patients and you should ask at your hospital to explain what their policy is, as you may be entitled to free or reduced cost parking.
In Scotland parking is free except for at 3 privately owned hospitals in Dundee, Edinburgh and Glasgow. Parking is also free for people in Wales except for a few hospitals who have external contracts in place. In Northern Ireland parking is free for chemotherapy and radiotherapy patients.
Blue badge scheme
This scheme provides parking concessions for people with severe mobility problems. The badge allows the holder to park closer to where they need to go. To apply for a blue badge you should contact your council. In London there is a green badge for Camden, red for the city, purple for Kensington and Chelsea and white for Westminster.
Disabled rail cards
You can get a disabled rail card if you have difficulty travelling by train. You get 1/3 off rail fares for you and a friend. To be eligible you need to be getting PIP or DLA. You can apply online at National Rail and there is a charge of £20 for a full year’s discount.
Disabled bus pass
This follows the same principles of the Disabled rail card and is available in England and Wales only. To get this you need to contact your local council.
These cards have messages on to tell the drivers what help you would like during your journey and include such things as, I have mobility problems and need more time to sit down. These are available from Arriva, Stagecoach, Metro and First Group PLC – Hampshire.
EARLY RETIREMENT DUE TO ILL HEALTH
If you have cancer and are in paid employment, your employer should support you and make reasonable adjustments to allow you to do your job during and after your cancer treatment. Legislation protects you from being treated unfairly at work because of cancer.
If you live in England, Scotland or Wales, the Equality Act 2010 protects you. The Disability Discrimination Act 1995 and its extension, the Disability Discrimination Order of 2006, protects you if you live in Northern Ireland. Macmillan Cancer Support has produced a comprehensive booklet called ‘Your rights at work when you’re affected by cancer’ for anyone (including carers) who want to know more about their rights at work.
If you feel that you are too ill to carry on working, it is important that you weigh up all the other options available to you, such as flexible or part-time working or voluntary redundancy, and make sure that if you do retire early you will be able to support yourself financially. Applying for ill health retirement can be a long process, so do bear this in mind if you decide to take this route.
How to apply for ill health retirement
If you are a member of a workplace pension scheme, and feel unable to return to work, you may be able to apply for ill health retirement (IHR). Whether you will be granted IHR depends on your pension provider, the scheme and their own definition of ill health. If you are seriously ill, and it is unlikely that you will be able to work again, you may be able to draw your pension benefits early, regardless of your age. You should speak to your employer and scheme administrator/pension provider to see if this is possible. Some employers, often smaller companies without a human resources department, may not have experienced a request for ill-health retirement before, so you may have to do your own research.
If you belong to a trade union they may be able to guide you and your employer through the process. If you do draw your benefits early, they may be lower than the benefits you would have received if you had continued working until your expected retirement date. Some schemes have two tiers of payment whereby retirement benefits may be paid without any reduction for early payment or may be enhanced to what would have been payable if the employee had worked until their normal retirement age. In cases, where your life expectancy is expected to be less than one year, the scheme’s rules may allow you to take the whole value of your retirement benefits as a tax-free cash lump sum.
A report provided by your Oncologist and an independent medical advisor (e.g. Occupational Health Doctor) are usually required. The Pensions Advisory Service website has further information on workplace pension schemes and ill health retirement.
Different schemes will have their own specific qualifying conditions, for example length of membership of the scheme and whether the employee is considered to be permanently incapable of undertaking their present duties or undertake any other regular work.
There is no provision for claiming your state pension early due to ill health, even terminal illness.
OVER 50s LIFE ASSURANCE
There can be few circumstances where having an incurable illness can work in your favour and lead to a useful sum of money being paid out on your death to assist your family with inescapable expenses such as funeral costs. These plans are often promoted by well-known celebrities, offering enticements such as free pens and televisions and, most importantly, no need to undergo a medical or declare any serious health issues.
How do over 50s plans work?
Plans promise a fixed lump sum when you die, so no investment risk and you know exactly how much money will be paid out. No medical required between ages 50-85. The amount paid out depends on what age the plan is started If you die within the first two years of the plan, you get back what you paid in pus 50% on top.
Too good to be true?
Some financial experts advise extreme caution with these plans, certainly if you currently have no underlying serious health conditions and even suggest that your money would be better off in a reputable savings account. It might be wise, therefore, to consider the following:
- These plans lock you in – premiums must be paid for life, there are no breaks in payment allowed and if you miss a payment, your plan will end without paying out
- The longer you live, the more you will pay in over time, yet the lump sum remains fixed – thus you could end up paying in more in premiums than is paid out on death
- The fixed lump sum does not keep pace with inflation
If you have poor health, over 50s life assurance plans can be lucrative
If you are likely to die sooner than the average life expectancy, these plans can work well for you and your family. For example, if you’ve an already diagnosed medical condition like incurable cancer, or you’re a heavy smoker or seriously obese, these plans can be a good gamble because you don’t need a medical even though your life expectancy will be substantially lower.
As an example, if we take someone with poor health at 65 who is likely to live until 70, they could take out a £74 per month plan which would pay out £14,320, while they’d only have paid in £4,400 – they’d get a whopping gain of almost £10,000. If they died during the first two years they’d just get back what they’d paid in plus 50%, still not a sum to be sniffed at.
You can find more information and comparisons of different companies’ plans by visiting the Money Saving Expert website.
TRAVEL INSURANCE FOR PEOPLE WITH ADVANCED BREAST CANCER
Travel insurance is important for all travellers, and is designed to compensate you for things that may go wrong whilst you are away, typically loss of luggage and personal belongings, theft, cancellation and, most importantly, medical expenses. If you do not have medical expenses cover, the cost to you could be huge if you need medical treatment in another country or need to be flown home.
It can be difficult to get travel insurance if you have advanced cancer because understandably, insurance companies think that you are more likely to need treatment whilst abroad and though they may offer insurance, the premiums can be prohibitive. Insurance for travel to Europe tends to be the cheapest, whilst the most expensive are the USA, Canada and the Caribbean where healthcare costs are high.
Living life to the full
When given the news that cancer has reached an incurable stage, many people will reassess what is important in their lives and for some, holidays and fulfilling a desire to visit areas of interest in the world become all important. Foreign travel will appear on many “bucket lists”, as people seek to make the most of their remaining lives, often raising money for charity as they do so. New experiences and memories can make all the difference to families at such an otherwise difficult time.
Finding an insurance company
You may find that travel insurance offered by high street agents is prohibitively high so you may wish to get quotes from those companies that specialise in travel insurance for people with medical conditions including cancer. The following companies do not usually feature on price comparison websites but have been suggested by people with advanced breast cancer who have found them helpful – there may be others offering comparable quotes if you shop around. An insurance broker may do the groundwork for you.
0800 022 3213 | insurepink.co.uk
0845 230 7159 | insurancewith.com
0844 335 3535 | eurotunnel.com
01223 446 914 | freedominsure.co.uk
Good to Go Insurance
0844 334 0160 | goodtogoinsurance.com
AllClear Insurance Services
0845 250 5350 | allcleartravel.co.uk
Age UK Travel Insurance
0800 085 3741 | ageuk.org.uk/travelinsurance
InsureCancer (Medi TravelCover Limited)
01252 780 190 | insurecancer.com
It’s So Easy Travel Insurance
0844 357 1315 | itssoeasytravelinsurance.com
J.D. Travel Insurance Consultants
0844 247 4749 | jdtravelinsurance.co.uk
Orbis Insurance Services
01424 215 315 | orbisinsurance.co.uk
Travel Insured (part of Manor Insurance)
0800 027 6171 | travelinsured.co.uk
0845 647 2777 | miatravelinsurance.co.uk
The British Brokers Association (BIBA)
0370 950 1790 | biba.org.uk
What you need to tell insurance companies
You are required to disclose fully any information about pre-existing conditions. If you do not provide all the information and try to make a claim, the company may refuse to pay out due to being misinformed. You will be asked many questions about the stage and grade of your illness along with any ongoing treatments and prognosis and be asked to provide a letter from your doctor confirming that you are fit to travel. If you have a terminal illness or do not have a doctor’s letter saying you are fit to travel, then you may struggle to find a company to insure you. Some companies may provide cover with an increased premium or excess or only give you cover for other illness or accidents that are unrelated to your cancer.
Incurable cancer/terminal illness
This is a difficult and emotive subject which can cause great problems when trying to obtain travel insurance as most insurance companies (including those providing life insurance cover) are very specific in their terms and conditions regarding the definition of “terminal”.
“Terminal illness is a disease that cannot be cured or adequately treated and that is reasonably expected to result in the death of the patient within a short period of time. This term is more commonly used for progressive diseases such as cancer or advanced heart disease than for trauma.” en.wikipedia.org
Some doctors prefer not to describe a patient with advanced cancer as “terminal” until they have no more treatment options, whilst others will say that the illness is terminal but not at the end stage whilst treatment is ongoing. Other doctors are far more blunt and quote a median survival time of between 18 months and 3 years once diagnosed with incurable cancer.
Insurance companies tend to use 6 –12 months as the expected survival time for a person considered to have a terminal prognosis, even though doctors and patients know that this is an arbitrary figure since nobody can predict with any accuracy how long an individual will survive. Problems may arise for patients who have been given form DS1500 in order to claim Personal Independence Payment (PIP) benefits which states that life expectancy is considered to be less than six months. Patients dealing with the trauma of a life-limiting disease often prefer to believe they are living with cancer rather than dying from it, so will understandably wish to get the most out of their remaining lives, without having to “prove” whether or not they are “terminal”.
Travelling without cover for cancer-related illness
Many people will do this and hope that they do not become ill or suffer an accident whilst abroad. It is worth remembering that whilst a condition may not seem directly related to cancer, the disease and drugs used to treat and control side-effects can make individuals more susceptible to infections, blood clots and falls which may then be attributed to your cancer diagnosis and nullify any subsequent claim.
You should always check exactly what your policy will cover you for and have a contingency plan should you become ill and need to get back to the UK quickly.
Choosing your destination
You are advised to choose your destination wisely, taking into account the length of flight and standard of healthcare in the country you are visiting. You may have to accept that there are some countries which are just not suitable for you to visit. You may be unable to receive certain vaccines if your immune system is compromised. Check with your doctor if you need to take preventative measures – for example, compression stockings to lower your risk of a blood clot or prophylactic antibiotics. Keep your drugs with you along with a letter from your GP or Oncologist confirming the drugs are for you – this is particularly important if you are taking opioids which are controlled drugs.
Macmillan Cancer Support have produced two booklets with information for travellers.
The European Health Insurance Card (EHIC)
An EHIC card entitles holders to get free or reduced cost medical treatment in state-run-hospitals in EU countries and in Iceland, Norway, Liechtenstein and Switzerland. You will receive the same care that residents of that country get but this may not be to the same standard as our own NHS. You may have to pay for some treatments up front and then claim the money back later.
The card will cover you for the treatment of pre-existing medical conditions but you should remember that the EHIC may not always cover the full cost of any treatment and will not cover the cost of getting you home in an emergency, neither does it cover lost or stolen property. It is therefore advisable to arrange private travel insurance as well as taking your EHIC with you.
PALLIATIVE & END OF LIFE CARE
Palliative care is used to help you and everyone affected by Secondary breast cancer achieve the best quality of life possible. Palliative care can be given alongside treatments such as chemotherapy. Palliative care aims to:
- Improve quality of life
- Provide relief from pain and other symptoms
- Support life and regards dying as a normal process
- Combine psychological and spiritual aspects of care
- Offer a support system to help people live as actively as possible
- Offer a support system to help family cope during an illness and bereavement
There are a number of people who will provide palliative care and these include your GP, community nurses or Marie Currie and Macmillan nurses. Social workers will also be involved to assess your care needs. These specialists will all work together to provide the best palliative care possible as well as meet the needs of family and friends. Palliative care can be given in your own home, at a hospice, in a hospital or in a care home.
The aim of hospice care is to improve the lives of people who have incurable illnesses which includes advanced breast cancer. Care also extends to the people closest to the patient and into the bereavement period after the patient has passed away.
As with palliative care, hospice care can be carried out in the persons own home, as an in-patient at hospital or in the Hospice itself. Hospice care includes:
- Occupational therapy
- Complementary therapies
- Respite care
- Providing pain relief from symptoms
A palliative care team at a hospice can help to control symptoms such as pain or breathlessness early on in the illness and not just at end of life. Hospice care is free and you can contact a hospice personally but the hospice will usually ask for a referral from your GP or nurse.
End of life care
End of life care is for people who are considered to be in the last year of life and can be given at home or in a hospice/hospital.
Five priorities for care – experts have agreed that there are five important priorities for the care and support given to patients and their carers:
- You should be seen by a doctor regularly and if they believe you will die very soon, they must explain this to you and the people closest to you
- Staff involved in your care should talk sensitively and honestly to you and the people close to you
- You and the people close to you should be involved in decisions about how you treated and cared for, if this is what you want
- The needs of your family and other people close to you should be met as far as possible
- An individual plan of care should be agreed with you and delivered with compassion
Further information on end of life, palliative care and hospice care can be found on the following websites:
Cancer-related fatigue is the most common side effect of cancer. Cancer related fatigue is very different to everyday fatigue, it is much worse and can last for months to years.
Cancer-related fatigue is being tired physically, mentally and emotional and sleep doesn’t make it any better. Everyday tasks such as making a telephone call or shopping can be overwhelming tasks to someone with cancer related fatigue. Signs of cancer-related fatigue include:
- Prolonged, extreme tiredness after an activity
- Feeling weak, tired, weary or exhausted even after sleeping
- Heavy and aching joints
- Having trouble concentrating or remembering things
- Not doing normal day to day activities
- Feeling frustrated, irritable and upset about the fatigue and its effects
Always speak to your doctor, if you are struggling with fatigue, they may want you to take some test in order to rule out any medical problems that is causing your fatigue. There are things that can be done to help manage fatigue, including:
- Rest, but not too much – plan your day so that you have time to rest. Take short naps (30 minutes) rather than one long rest period. Too much rest can decrease your energy levels. Try to sleep 7-8 hours each night although if you have trouble sleeping you need to talk to your health care team
- Stay active – stay as active as you can, moderate exercise especially walking has been found to be a good way to ease fatigue
- Save your energy – prioritise your activities. Decide which are important and what are not important and plan your activities so that they can be done throughout the day and you can then take rest breaks between each task. Be careful not to push yourself, know your limits
- Get help – ask family and friends to help you with the things that you find most difficult and tiring
- Eat well – drink plenty of water and juices. Try to eat at least 2 cups of fruits and vegetables each day and make sure you get enough protein and calories to help your body heal
The above may be helpful to some people but not for others as people have variable levels of fatigue. This information is extracted from cancer.org and if you require further information please see their website or go to macmillan.org.uk
DRIVING & CANCER
You must inform the DVLA if you develop a medical condition or disability that can affect your driving. You must surrender your licence if your doctor tells you to stop driving because of your medical condition.
The DVLA will assess your medical condition or disability and may decide any of the following:
- Whether you need to get a new driving licence
- Whether you can have a shorter licence for example 1, 2 or 3 years and you will have a review at the end of that period
- If you need to adapt your car by fitting special items
- Whether you need to stop driving and give up your licence
You will usually get a decision within six weeks and they may contact your consultant, arrange for you to be examined or ask you to take a driving assessment, or an eyesight or driving test. You can usually drive whilst the DVLA are considering their decision.
Please be advised that you could be fined up to a £1000 if you don’t tell the DVLA about your condition which may affect your ability to drive safely. You could also be prosecuted if you have an accident.
For more information please visit gov.uk/health-conditions-and-driving
TRAVEL & CANCER
Before you do travel, you should:
- Talk to your oncologist or doctor who can advise you whether you are fit to travel or not
- Plan well ahead so that any special arrangements can be made in advance (eg arranging early boarding of flight)
- Be realistic about where you want to go; whether home or abroad, look at the facilities the hotel offers for disabled people and make sure they are adequate for your needs (e.g can they offer ground floor apartments or rooms and if they have lifts)
- Also look at the facilities nearby. Are they close enough for you to walk there or do you need a wheelchair to get around? It is also important to make sure there are hospitals nearby in case of an emergency.
- You will also need to consider what the climate will be like where you are going as your skin can be more sensitive to the sun and you may be at more risk of getting an infection
Plan how much medication you need to take to see you through the holiday and you may need to make special arrangements for example, taking a letter from your doctor and a copy of your prescription.
Depending on what treatment you are on, certain vaccinations may not be possible so check with your doctor first before choosing a country that needs special vaccinations.
Deep vein thrombosis
When travelling you may be more at risk of developing deep vein thrombosis which is a blood clot which occurs in a deep leg vein or a larger vein that runs through the muscles of the calf and the thigh. Consult your doctor before travelling long distances or are flying to your chosen destination.
If your journey or flight lasts more than six hours, you should:
- Drink plenty of water
- Avoid excessive alcohol as it can cause dehydration
- Perform simple leg exercises and go for a walk if possible
- Wear elastic compression garments
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