88 Years Old, Stubborn, Wants to Fly

[UkrainianTracksuit]

We have a big problem.

I am getting married and my grandfather insists on going to the wedding.  He’s 88 and on HD 3 x a week.  Before you ask, no, I can’t get married in Canada or the United States because I guarantee my fiance would never get a entrance visa right now.

My parents said they would make arrangements for my grandfather to stay in a nice care facility while they are gone.  He said no way.  He is capable to stay at home alone too.  He has all his wits and capabilities.  My parents offered him to stay at home but to have a close friend stay with him or check up on him.  He said no way.  They offered a spa-type setting with mentioned close friend to transport to dialysis/take care of him.  Again, no way. 

My parents told him it is difficult for people of advanced age to travel as it is.  It would be even more difficult for a patient of advanced age on HD to travel internationally  It could be really terrible for his health.  Death is an option.  He said he’s aware of it but even if he has to take a boat, he’ll go.  My parents told him that they’ll just leave, make arrangements for someone to care for him and there’s nothing he could do about it.  He said he’d report for them for abandonment.  He’d also burn down the home and disown them.  Yeah, he’s VERY rebellious.   

He’s travelled while he’s been on HD.  The social worker has arranged for him to have HD sessions in Miami and New York.  Everything worked out fine but it was the same hemisphere.  If something happened, he was “close-ish” to home.  He travelled with either both my parents or my father.   

The main option being floated around is to break up the flight to short flights and then have arrangements made to go to dialysis the next day.  The median used is a flight from Toronto to Miami. (approx: 5 hours)  Or, as my grandfather says: "I spend 4 hours with my ass tied to a chair.  What's the deal if it's in the sky?"  To get to RU, this is the plan:

Toronto to London (non-stop, approx: 7 hours)
(spend a few days in London, have HD, meet some old friends, relax)
London to Moscow (non-stop, approx: 4 hours)
(arrange for HD, see friends and more social stuff, relax)
Moscow to Rostov-on-Don (non-stop, approx: 2 hours)
(main “base”, have HD, spend desired time here)
And then, trips in the region by car.

In these cases, the care providers would be my parents.  On the other hand, they are willing to spring to hire medical escorts.  In fact, they’re leaning towards medical escorts to aid them.  Second point is that even though my grandfather can walk, they’ll utilize a wheelchair to ease the tiredness.  I think hiring someone from an agency would be the real reason they'd "let" him go.  He's worn them down but they do know there are professional options if this means to much so him...   

I’m aware that flights shouldn’t/can’t be booked until the dialysis sessions are finalized.  I’m just really worried.  It’s a really big endeavor and he hasn’t flown this far since he moved to Canada.  On that day, it was one long day of travelling and then early dialysis the next day.  But, this is almost a decade later and he’s in his late 80s.  I’ve been googling and finding stories of people in their 90s still flying but they aren’t on dialysis. 

I wish he would understand that while I appreciate him wanting to be there badly, his stable health is more of a gift I could ever want.  Then I wonder, if his health is stable, and he has the utmost care, what is going to be is going to be.  Maybe he needs this trip as closure? 

With medical escorts, two helpers (aka parents) and the RSW arranging treatments, what are your opinions?  What would you do?    

[iolaire]

It seems completely manageable to me, but then I'm almost 40, travel a lot and still have some kidney function. 

The multiple stop itinerary you have seems like its adding a lot of time to the one way Toronto to Rostov-on-Don itinerary.  It looks attractive to allow him time to visit friends, but if you are worried about the effects of travel I wonder if it might just be best to do Aeroflot direct (I have not flown them)  YYZ -> SVO -> ROV, its under 14 hours on the outbound but requires an overnight in SVO (Moscow) on the return.

I guess what I'm saying is its 9 hours to Moscow direct versus 7 hours to London - so if the air travel is perceived as a risk does it make sense to stop over in London?

[UkrainianTracksuit]

Thanks iolaire for the response.  It’s good to get some input from a traveler.

See, this is why it is good to have another set of eyes looking at flights.  My parents aren’t too savvy online and they insisted there were no non-stop flights to Moscow.  You mentioned it and there totally are.  It doesn’t make sense to fly 7 hours and stop when the major part of the journey can be completed for a few hours more.  That would take out some extra dialysis bookings and confusion too.  Once they hit Moscow, everything will be home free so to speak. I don’t think they’d mind at all having to have an overnight in Moscow on return either.  Thanks for being on the ball and aware.   

I will pass this information on to them and show them options for direct flights.  Aeroflot is usually delayed, like a common characteristic of their service, but if it is a direct flight, it’s a small price to pay.  I know many people complain about the rude service but that’s just the culture.  They’ll be used to it!  They have improved their safety record too.

The renal team thinks this is an insane idea and I agree.  However, if it is his wishes, we owe him the best to 'investigate'.

Thanks for the advice. 

[iolaire]

Glad I was able to help with ideas... that was the second set of flights that I thought about today for other people.  Its really not that complicated to pull up Kayak and look at the options, but if you don't know where to look it has to be daunting.  Also I'm at the point where I'm thinking more about simple connections even if it costs a bit more to keep the comfort up, so I'll question more complicated routes.

[UkrainianTracksuit]

Small update.  I know it's not important but maybe this strange situation can help someone in the future.  And to end, a really dumb question.

During today's HD session (this info is minutes old) the RSW/one neph discussed concerns with my grandfather.  Health concerns, effects of travel, it's a big deal on an old (dialysis ravaged) body.  They know he has his wits but wanted to see if he understood the magnitude of the bombshell he landed on them.  There's going to a "meeting" on Friday to discuss everything.

My parents told me to keep my nose out of it because I have enough on my plate right now.  I shouldn't be concerning myself with "logistics".  But I'm worried and confused and just well, making this face:   

Iolaire, again, thanks, and I directed my parents to use Kayak.  They called it Canoe or "the boat place" a few times.  Yeah, they live under a rock and probably forget they've seen the commercials.

What's the usual waiting period for an RSW to make contact/book HD sessions?  Especially in non-touristy places?

Thanks.

[Rerun]

I'd pull he guilt trip.  Assuming he is your Father's Father.  Dad should tell Grandpa that He is just going to stay home with him and make sure he gets to dialysis etc... She (you) will just have to walk yourself down the isle.  Or if he is your Mother's Father then she can try to guilt him into staying home by saying she will just stay home with him to make sure he gets what HE needs (cuz it is all about him)...

If he does have his wits about him.  That would crack him.  He would come to his senses and stay the hell home and enjoy pictures.

[UkrainianTracksuit]

The good thing about weddings here is that fathers don't have to walk daughters down the aisle.  The couple has to do the 'walk of shame' together.  We just need our parents for the following civil ceremony.  Maybe I'll rent some robots and solve everything. 

The guilt trip should also still be on the table and you're right that it is 'all about him'.  He's had all sorts of cognitive testing which prove that he has all his wits.  I hope by Friday some sense creeps into his very stubborn mind.  Keep in mind, I'm going to pass your guilt trip theory on to my parents.  I know they're leaning towards a medical escort type agency.  However, for the price of that, Gramps could have the trip of a lifetime to LA, Las Vegas or Miami (easier flights, dialysis friendly) and get himself his own new wife.  In this whole situation, while we love that it's keeping him vibrant, all I can say is 'damned dialysis!' 

To solve everything and ensure people do not feel 'left out' as the complaint we hear, we should simply have no ceremony.  It's always an option.

[iolaire]

I've been wondering what the true risks are for him to fly.  So my first Google hit was this:
http://ageing.oxfordjournals.org/content/31/1/17.full.pdf
At first glance it looks like there are elevated risks (but I don't understand them enough to fear them), but I think what you would be most is the Precautions of the older air traveler on page 20 which suggests some tests that can be done in advance to screen the elderly.  Also you might consider bring him to a travel clinic, say its to get his shots, to get their profession take on the risk of travel (and to make sure he is up on his shots).

[UkrainianTracksuit]

Thanks iolaire for that journal.  It was really interesting and addressed concerns I had about elderly and long haul flights.  (Stroke and heart failure.)  I’ll have to email it to my parents and translate the important parts.  (Concerns and possible physician testing.)  I’m simply wondering, if flying is difficult on the circulatory system of a general older person, what about a person on HD?  As we all know, it causes issues with the heart.  As of right now, there is certainty he has no heart problems.  I guess another medical work over is a logical plan out of all of this.  That is, if he logically still wants to go and is dead set on it.  I’m sure my parents will still attempt some psychological torture to let him decide otherwise soon!  Anyways, I better email that article and get translating ASAP so they have it for the meeting.  Oh yeah, shots never even entered my mind.  Hep B is a biggie.

When I look at cases of elderly people (I’m talking 85 and up), the prognosis is not good.  Many times I’ve come across information saying, “they’ll die in the first year..” or “like anyone, they’ll get 5 to 7 years at best” or simply, “dialysis could be a curse on someone this age.”  I know HD is a tough go and I hate it.  I know all of the “side effects” of it from cramping to vomiting to feeling tired.  And I know, in the posts/articles/cases I’ve read, that it would be so much tougher on someone of advanced age.  We are not being blind to things nor are we being naïve but I can honestly say my grandfather is thriving on HD.  Heck, he still has a head full of naturally dark hair! As he says, he would “feel great” if it wasn’t for his arthritis.  This is after 9 years of in center HD.  From his last work up, his heart looks good.  As for his routine tests, his blood is good too.  Everything is in perfect ranges.  So, what I am saying is that while I understand outright to raise this question, this whole thread, seems like he has a death wish since one considers a chronically ill traveler on a form of life support insane, I “sort of” see where he is coming from. 

I think because he thinks he flies short distances (5 hours), that an international flight would not be a problem.  And trust me, I know that absolutely everything would be done under the sky (bad pun..) to ensure he would get there in one piece.  However, bodies are bodies.  Older bodies are weaker and flying doesn’t help (as the article pointed out).  If he was as he is without dialysis, there would be no questions.  It’s just old age + effects of dialysis on the body + flying a long distance = big chance for problems to happen.

I am not concerned with him actually receiving in center HD in Moscow or Rostov-on-Don.  There are clinics in both cities that provide good care.  He still has citizenship, a distinguished citizen at that, so he does not have to worry about costs.  It is the damned stupid flight.

O.K. to summarize: worried about a stroke, cardiovascular catastrophe, he’s in generally good health, wondering about the effects of HD on the elderly as they fly..

I apologize for this verbal diarrhea reply.  I’m just floating thoughts.

[iolaire]

Your concerns and thoughts make sense.

But, now I’ll get potentially controversial.

First let me say that you seem to be thinking this through and trying to help – likely there is no clear right or wrong - so my statements are just my opinion.  Please don’t get offended on by my comments, they are just the point of view of some random outside… In the end it’s some sort of decision between your grandfather, you, your parents and other care givers.

When I see your worries about your grandfather’s potential death from travel I’d counter with something along the lines of: “What are you keeping your grandfather alive for?” as in what is the goal?  Are you hoping that he have a fulfilling life for as many years a possible?  If so, are your shared experiences during the remainder of his life less important than the raw number of years he lives?

Not being in your shoes I’d see the trip as something that he will look forward to, it will enrich his life both before and after the trip, and would be something that makes him happy and make him more likely to keep trying to pull through day by day.  To me that would have more of a positive effect on his outlook then forcing him to miss that happy occasion… 

Its experiences like your wedding that makes life worth living, more than weekly dialysis sessions or playing it safe.

I’m generally a positive person and think that things will work out, so I look at life expectancy studies and note that positive things like having a living spouse, having a pet or a hobby helps people live longer.  I’d lump travel in there and think questions along the lines of: of would it be that bad if he passed away in route to/from your wedding?  i.e. is a dead grandfather who was excited to be in transit to a family event worse than a mad grandfather who hung on for a few years but blamed the family for not letting him return to his home country etc…

It’s morbid but is it better to miss family events (against his will) or live longer?  My gut feeling, being an outsider, is to let him life his life to the fullest extent possible, do what you can to minimize the risk, but error on the side of a fulfilling lifestyle and minimize the disappointments.   

Once an elderly person starts to give up it’s a problem…

[Jean]

iolaire and I are in complete agreement. There is more to life than just being alive. If he wants to travel, let him do it. He is what, 82?? So how long are you thinking he should live.? Death is a part of life. If it was my loved one that wanted to come, I say, let him come and enjoy himself ( and me) for as long as he can.

[amanda100wilson]

 Ok.  I am going to do a different take on this. Supposing your grandfather does fly, and he suffers a serious adverse health effect.  The financial cost for your family could be huge.  This occasion should be about you and your husband yo be, not about worrying about your grandfather.  His attitude towards this seems to be very manipulative.  The thing that springs to mind as a side effect for a long flight for someone older are deep vein thrombosis and pulmonary embolus.  My in-laws fly to visit us twice a year from the UK, they are 83 and 79 and over the years I have seen the nine hour trip becoming much more wearing on them.  It is not just about the flight time, but also all the added time before boarding the aircraft. 

[UkrainianTracksuit]

Thanks iolaire, Jean and amanda100wilson for all your thoughts.  I’ll try to make this a quick but logical reply before I rush out for the day.

Iolaire and Jean, both of you make excellent points.  I think of the old adage: we’re on dialysis to live, not live to be on dialysis.  Granted, I know he will not live forever and furthermore, it would be selfish to “corral” his life so that he lives but didn’t get to do the things he wants to do.  With this train of thought, I support him being strong willed and wanting to travel.  I know that he will have more resources available than the average elderly/chronically ill traveler so in the end, if this insanity does happen, all will be done to aid him.   

I came across an interesting article about ‘foreign travel for advanced cancer patients’.  While comparing an elderly patient on HD to an advanced cancer patient is like apples and oranges, the article stated, again, ‘problems specifically related to a patient’s care are rare’ in reference to air travel.  It listed the same types of medical concerns as the article on elderly travelers that you found, iolaire.  I think the common here is that int. travel can be a bit of a reprieve or the last chance to be at peace.

Amanda100wilson, you make REALLY strong points too.  I worry about deep vein thrombosis and pulmonary embolism.  Those are on my list of concerns no doubt.  Any type of travel is difficult on elderly people and especially, an elderly person that is chronically ill.  I know that my parents are willing to shell out an obscene amount of money IF this insane plan comes to fruition.  I know they have considered the whole “what if..” situations such as medical emergencies or death.  On a morbid turn, during typing this, I looked up repatriation fees for a body and they are high as well.  I think all of this money being tossed around could be put towards a less stressful and more enjoyable vacation for Gramps.  His heart might be set on RU but he could have just as great a time somewhere closer.  I just don't think I could be on board with the risks. 

In the meantime, I’m going to spend some time today on a last ditch attempt/phone calls about getting my fiance a visa.  Then, the only chronically ill person that has to travel is me!    

Thank you, posters, for your thoughts.  I see a ‘yes’ and ‘no” debate brewing in my head from these posts.  Like my parents said, I shouldn't be concerning myself with this but I highly doubt they'd be getting input from other dialysis patients.

[MooseMom]

UT, if there is ANY way at all that your fiancé can get a visa, it would solve all of your problems.  What exactly is the problem?  I'm curious!

[UkrainianTracksuit]

Hi MooseMom,

Yes, if he could get a visa, this whole problem could be solved.  Without getting too personal, he has a point under Canada's rules for inadmissibility.  All of it would be apparent too when/if he supplied supporting paperwork or simply answered the application truthfully.  I will urge him to apply anyways: all they really can say is no, and then we shall know for sure.   

I don't know how the meeting went today over this insanity.  I know my grandfather really wants to meet this guy but I explained something will be worked out WITHOUT the huge endeavor.  Funny, he's lived all these years and never learned patience.

I got nowhere today about the visa.  However, in speaking to a colleague, she suggested we meet in a country where visas are not required.  Off the top of her head, she said some countries in South America, Central America and the Caribbean do not require Russians to get visas.  I can fully admit I am ignorant about these countries.  To me, it is cliché to have destination weddings in these places (sorry, if that is mean), wonder if they even have RU Orthodox churches and I know NOTHING about HD there.  Dialysis is dialysis but I think I would be out of my comfort zone, grandfather too, in places we don't know.  I don't know the quality of the clinics (haha, strange words coming from an Eastern European..)  and again, we'd be zoning in on 5 hour flights.  However, if care is great there, I would consider it.     Anything to make my family happy...

Sorry MooseMom, you didn't want to hear me complain and babble.  You asked a simple question to which I gave a vague answer.

[MooseMom]

Forgive me please, UT, for having asked an uncomfortable, personal question.  You certainly don't owe me any answers!   

It all sounds really complicated, and it must be so hard for you to try to accommodate everybody.  I hope your grandfather appreciates all you are doing to try to make his travel dreams come true.  It sounds like a hard trip at the best of times!

This might be a stupid suggestion, but is there anyway that he could "attend" your wedding via Skype?

[Gerald Lively]

I want to fly too.  But I could never get my arms flapping fast enough.
If you don't let this guy fly, he will regret it for the next thirty years. 
Let him decide.

[obsidianom]

I wrote a long message on theis and at the end my computer ate it. (i hope it chokes on it)
I rarely give non medical advice but I will wade in. I am older than many of you here and treat many quite elderly patients (well into their 90s) . So I have a different perspective.
LET HIM GO !!  He has probably been waiting for this day since you were born. Many grandparents do. Now when you finally are to wed you cant take this away form him. When you are older death and the threat of it are less scary and you are willing to risk more than a younger person who has a long life ahead. Special moments are aften all we really have left. Taking as  big as this away  be like injuring his heart, it could send him into a depression or worse and that would lead to his demise. If he dies doing it at least he will die happy . Dying angry and bitter at home because he isnt allowed to go is no way to die.
His choice is clearly to risk it. Let him. He loves you and his family.  Isnt that what really matters. ?

[UkrainianTracksuit]

Sorry for not answering your question sooner, MooseMom.  Busy weekend and then work and then HD and then slept for hours.  Anyways, Skype is also a good option if things do not turn out well.  I'll have to inquire about wifi and the church.  It would be my fiance's parish so I'm unsure.  I wonder how "techy" a church could be? Thanks for thinking outside the box.  They have Skype on mobile too, don't they? [Yes, I am not a tech person..]

Thanks Gerald and obsidianom for your thoughts (and a little joke) too. Thanks for your perspective, obsidianom, as you have further experienced in dealing with the aged.  You give well thought advice so even if it is not medical, thanks.

As per the meeting on Friday, a slew of tests are going to be completed.  Mainly cardiac and pulmonary testing.  Blood gases too.  He had a brain scan recently and that looked good so that doesn't have to be redone.  The simple tests kick off Thursday.  Funny enough, one of the nephs dealt with a similar situation about 4 years ago.  A 93 year old man (not on dialysis, just kicking around Stage 4) went to Cyprus for vacation with his family.  He's still alive, kicking and active.  I'm impressed!  Anyways, with the news that they're offering tests, my grandfather is 'happier' as he sees that maybe, just maybe, he'll get to go.  It may not be his final goal but it could be the beginning.

[talker]

Sorry for not answering your question sooner, MooseMom.  Busy weekend and then work and then HD and then slept for hours.  Anyways, Skype is also a good option if things do not turn out well.  I'll have to inquire about wifi and the church.  It would be my fiance's parish so I'm unsure.  I wonder how "techy" a church could be? Thanks for thinking outside the box.  They have Skype on mobile too, don't they? [Yes, I am not a tech person..]

Thanks Gerald and obsidianom for your thoughts (and a little joke) too. Thanks for your perspective, obsidianom, as you have further experienced in dealing with the aged.  You give well thought advice so even if it is not medical, thanks.

As per the meeting on Friday, a slew of tests are going to be completed.  Mainly cardiac and pulmonary testing.  Blood gases too.  He had a brain scan recently and that looked good so that doesn't have to be redone.  The simple tests kick off Thursday.  Funny enough, one of the nephs dealt with a similar situation about 4 years ago.  A 93 year old man (not on dialysis, just kicking around Stage 4) went to Cyprus for vacation with his family.  He's still alive, kicking and active.  I'm impressed!  Anyways, with the news that they're offering tests, my grandfather is 'happier' as he sees that maybe, just maybe, he'll get to go.  It may not be his final goal but it could be the beginning.

Wowie, what a read.   Wonder how this all turned out? 

[UkrainianTracksuit]

Just a quick update:

My grandfather "passed" the required medical testing and he was considered fit to fly.  His heart remains strong so that's good.  Well, he was forced to get a hearing aid though.    The day before the flight, his dialysis session was moved to the morning block so he had time to recuperate and have extra time in case there were blood pressure issues, cramping etc.  My parents were caregivers and they did hire extra help to escort him.  The flight went smoothly with the aid of some "anti-anxiety" medication.  They flew direct to Moscow and then a short flight south.  The direct flight to Moscow was key (I think) because he slept through it as though it was a night's sleep. 

The local dialysis sessions went well although he hated having to do it in a bed.  I think a warning for vacation time has to be that he encountered a lot of local food he missed that really impacted his weight.  (Lots of pickled foods.)

Another important factor was the use of a wheelchair.  Usually, he does all his own walking and gets tired out.  However, with a wheelchair, he was able to keep his energy and do more.  The aid of two caregivers plus a professional was indispensable also. 

He said he had a wonderful time and didn't want to fly home.  From what I was told, he was very exhausted on the flight back but that is understandable for someone that age.  He's (with the appropriate aid) is planning another trip to Miami at this point.   

It was a lot of investment of time and money but he thinks the risk was worth it.   

[iolaire]

Thanks for the update. I'm glad that the trip went well and he enjoyed his time there.

[bliss85]

i dont know why he couldnt take a direct flight i took a 15 hour flight to china and had no issues? im assuming he has some other issues besides dialysis restricting him from flying...my doctors has no issues with me flying at all...never even heard of dialysis patients having an issue flying. id be curious to know why they said he couldnt fly?

[UkrainianTracksuit]

Hi bliss85,

To answer your question, I think it was just the combination of dialysis and advanced age.  You're right; there wouldn't be a concern if it was "just" dialysis.  The advanced age was the kicker but he made it through.  Thanks for your comment.

[okarol]

Having just lost 2 elderly family members I will look at it from Grandfather's view.
At 88 you have no guarantee that you will wake up the next day. There are very few enjoyable things left in life.
Especially on dialysis. Each day is a gift.
Yeah, it might be all about him, but haven't we earned that by the time we hit 88?
He sounds like a great guy. I wish we still had my grandparents to share memories with.
The problem is, you always think you'll have time.
I am glad he made the trip!