By Christopher Elliott

For Carol Margolis, it was an almost-ruptured eardrum.

She'd flown with a bad cold and sinus congestion, which made it difficult to equalize the pressure in her ears. After her doctor told her she'd nearly torn the lining between the inner and outer ear, and suggested she stay away from planes for a few weeks, she grounded herself.

"My hearing is too precious to risk," says Margolis, who runs a travel Web site in Lake Mary, Fla. "I paid the change fees and stayed put."

Not everyone makes the same choice. A recent poll by TripAdvisor suggests 51 percent of air travelers say they'd rather fly while infected with the flu than pay a $150 airline change fee. A similar survey by found nearly 60 percent of travelers would fly infected instead of taking the hit to their pocketbook.

That's something worth considering as we approach the peak of the flu season. For every Margolis, there's at least one other passenger who refuses to cancel. Like Amanda, who asked me not to reveal her last name. She flew with the flu, even though she didn't want to.

"I called Southwest to bump my flight by a day, and while the rep was kind, she couldn't do anything but offer me the opportunity to pay the $300 change in fare," she says. "Since this was not a possibility for me, I reluctantly dosed myself with cold medicine and endured the unending stares of everyone on the shuttle, in the security line and boarding around me on my flight and endured the most miserable six hours of my life flying."


When Your Doctor Tells You To Stay Home

"Some symptoms are just too high-risk to consider flying at all," says Steven Schueler, an emergency room physician and chief executive of DSHI Systems, a health information systems company. If you suspect you may be too sick to fly, he recommends a medical risk assessment that considers both the seriousness of the symptoms as well the potential diagnosis. And if your doctor says don't fly -- don't fly.


The CDC won't necessarily come out and say, "Don't fly if you have such-and-such," but it does publish a helpful page on infectious diseases it's trying to shield travelers from. Certainly, it's safe to assume that if you have something like Tuberculosis, you might want to check yourself into a hospital instead of board a plane. The CDC site has suggestions to help avoid the spread of Swine Flu that should also be heeded.


The list comes to us courtesy of Michael Zimring, the director of the Center For Wilderness & Travel Medicine in Baltimore: Don't fly if you've had a significant sinus congestion, surgery on a lower extremity, a recent heart attack or cardiac surgery, uncontrollable heart failure, or recent abdominal or neurosurgery. "A patient of mine just had an emergency appendectomy and he wants to leave for Vegas in a few days," he says. "That is a no-no." Why? The patient will have residual air in his abdomen from the surgery and when he gets to altitude, the air will expand within the closed confines of his abdomen and cause major problems. Ouch!


"Generally speaking, someone should not fly if they are unable to walk about 150 feet or climb one flight of stairs without becoming short of breath," says Mark Gendreau, an assistant professor of emergency medicine at Tufts University School of Medicine. "Keep in mind that commercial flight subjects us to both physiologic and environmental challenges." Such as? Cabin pressure is set to 5,000 to 8,000 feet above sea level, he notes, which results in a lower oxygen saturation in your bloodstream, in addition to the expansion of gases in body cavities.


The worsening of an underlying anxiety condition can be a cause for cancellation, too, according to Margaret Lewin, the medical director of Cinergy Health, a Miami health insurance company. Fear of flying is no laughing matter to the estimated 1 in 5 people who suffer from it, and should be taken into account when you plan a flight. Aerophobia can be treated, and you should always have a Plan B. "You're best protected if you consider possible problems ahead of time," she says, adding that flight or trip cancellation insurance should be considered. Note that many policies have exceptions for pre-existing conditions, so only a "cancel for any reason" policy is likely to cover an anxiety disorder.

Another thing to consider is the return trip. If you're feeling unwell now, and decide to fly anyway, could your condition worsen by the time you're ready to return? Myles Druckman, the vice president of medical services for International SOS, a medical healthcare company, says it happens more than you'd think.

"It is good practice to only travel when you are well," he says. "If you have a symptoms of illness, you should address these concerns prior to travel, particularly if you plan to travel internationally. It is important to consider that your symptoms may worsen while on a trip, and this may require you to seek medical attention locally."

That's all well and good, but it would help if the travel industry -- particularly airlines -- loosened their onerous change rules when a customer fell ill. On legacy carriers, change fees and fare differentials often exceed the value of the original ticket, forcing passengers to choose between flying sick or throwing a ticket away.

No one should have to make that choice.

Christopher Elliott is the ombudsman for National Geographic Traveler magazine


© Christopher Elliott

Travel - Too Sick to Fly? When to Put Yourself on the 'No Fly' List