Category Archives: Healthy Travel

IAMAT. It’s free. You should join.

What happens if you are far from home, really sick, and don’t speak the language where you are? And nobody seems to speak yours either, at least not the people who can help you? Not good. Could you figure it out, or just push through? Sure. But that sucks, and isn’t necessary.

I happened across IAMAT when googling ways to magically make myself un-sick in time to leave for the Netherlands. I’d pulled references and information from them before but hadn’t joined. Now, with my new-found illness obsession, I checked a little more closely.

The TL/DR version:
1. It is free to join. If you join you can immediately download a membership card.
2. You can then log in and search providers worldwide who speak English and work with IAMAT.
3. There are set fees for non-hospital visits if you are booking with your IAMAT card. For a regular daytime office visit, it runs $100USD. That isn’t that bad for getting right in to be seen, and it is a negotiated cost with IAMAT so unless you have to go to a hospital there shouldn’t be additional fees for the visit. (Medication may be extra.)

I get nothing for referring you – IAMAT is not a sponsor. This is a straight up recommendation because why not?! It is free to join, and I’ve already gotten the address of medical offices in both Amsterdam and Rotterdam, the relevant phone numbers, and the names (and in two cases, emails) of doctors who have the agreement with IAMAT. At least now I feel better that if this gets horrible halfway through my trip, I’m not wandering aimlessly and hoping for the best.

It’s free. It’s peace of mind. You probably won’t need it, but what if you do? You should join.

The HUGE help list for travelers with dietary restrictions

Got milk?  I don’t!  I can’t do dairy at all because of lactose intolerance.  Not the sort that means you can only have one piece of pizza either.  Mine is sufficiently severe that even a pat of butter stirred into sauteed spinach can leave me curled up in a ball for hours.  Food restrictions are no fun at all.

It’s bad enough when this happens close to home.  When it happens on the road it makes me furious.  Let’s face it, when I’m  traveling I’m either there for  fun or for work.  Either way, if you  put me out of commission for the better part of a day you’ve screwed up my plans.

This post is for all of those of you out there with dietary restrictions of some kind.  I am not differentiating here between medical restrictions (allergies, intolerances, IBS diet, etc.), religious restrictions (kosher, halal), or voluntary restrictions (vegan, vegetarian, paleo, etc.).  If you have some foods that you cannot eat for whatever reason it can be a real pain in the ass when traveling, and that is good enough for me.

Tips for managing food restrictions away from home

This isn’t an exhaustive list, and please bear in mind that what works for me may not necessarily work for you – so be sure to listen to your body and your doctor before taking advice from the internet.

  • Figure out your “safe core foods.”  Even in the most restrictive diets, there are usually a few foods that are readily available and that are prepared simply (if at all) so you usually know what you are getting.  Come up with a list of at least ten of these that you know you tolerate well and don’t react to.  The simpler and less-prepared the better for this – think of it as a list of meal building blocks that you can eat on their own if need be.  My current list: rice, apples, citrus fruits, boiled chicken, tomatoes, most veggies if raw/steamed/boiled, white fish if poached/broiled without butter, shrimp, oatmeal, raisins, lean red meat if broiled without butter.  Looks very thin but I can usually find something to eat most places if I start from this list and stress no dairy.
  • Don’t be afraid to be a pest – ask more than once about anything that is medical, and remind your server (politely) before each new item is brought out.  More than once I’ve specified “no dairy, it makes me REALLY sick” only to have a server bring me nondairy goods at the start but then follow up with dairy for a second course or a refill for coffee.  They are always sorry, but when I don’t find out until after I’ve had a few bites and flagged them down and asked, it’s too late.  Pushy is fine when it is your health.
  • If you are headed somewhere far enough from home that the food is different (regional difference, or international), do some checking on common foods for that area and see what you might be able to safely try.
  • Are there ethnic foods that work well with your restrictions?  I find that if I can wander until I find a Chinese or Japanese restaurant pretty much anywhere in the world, I’ll be able to at the very least avoid dairy.  Be specific though with this one!  It isn’t enough to think “Asian food” or “Latin food.”  Chinese and Japanese places are safe for me but I have to be very careful if I go for Thai or Indian food – much more use of dairy there.
  • Find a few safe fast food options as emergency go-to’s.  Fast food gets a bad rap, but it has its place.   One of the best things about chain fast food is that the items on the menu are usually similar if not identical across franchises.  If you order McDonald’s fries in San Francisco, they are going to be the same fries in Columbus, Ohio.   Caveat:  This doesn’t work as well for overseas travel, chain restaurants have country-specific tweaks they do and you might be in for a surprise that won’t work for you if you don’t check ahead of time.
  • Bring digestive meds – a lot of them.  I’m always convinced that I am careful and will be fine on trips, and usually I am.  But that one time out of ten I’m not?  I am insanely glad that I have Immodium and Pepto chewables along.  The last thing I would want is to have to hobble around sick as a dog looking for a drugstore.
  • If dairy makes you miserable like it does me?  Go vegan on the road as needed.  One way to know for sure that your food doesn’t contain dairy is if you eat vegan.  Even if you normally eat meat but not dairy, going temporarily vegan will make sure that ‘hidden dairy’ like casein doesn’t sneak in and cause trouble.  (I react not just to lactose, but to other components in milk.  YMMV.)
Resources for managing dietary restrictions while traveling

Why remake the wheel when these good folks already have the information we need?

  • The information and search site is fantastic.  If I were allergic rather than merely intolerant, I would head here first.  From the site: “1) Click on U.S. Travel 2) Select your State 3) Select Your City 4) On the next page, you’ll find a listing of hotels with kitchens, health food stores, restaurants, and medical facilities.”  Drawback here is that only US travel is covered, but hooray for all of us road trippers!  Site also has a page covering airline policies of the major US carriers.
  • The blog Young Adventuress is written by a veteran traveler with a serious peanut allergy. She doesn’t let it stop her, and she explains why you shouldn’t let food allergies prevent you from traveling the world. Great for a pep talk if you are the skittish type.
  • Another world traveler with serious allergies, Robert Haru Fisher, explains how he stays safe and sees the world. I especially love the idea of printed translated allergen alert cards to give to servers. Great suggestions.
  • Found on the same site (IAMAT), a sourcebook of English-speaking doctors around the world.  Membership looks to be free and gives you immediate access to the information. I wish I’d had this when I got desperately sick in Finland – to this day most of that trip is a blur but I know how to say “pharmacy” in Finnish.  (It’s roughly pronounced “AP tek EE”. Now you know.)
  • If you aren’t handy or don’t trust your own skills at translation and printing, you can go here to get pre-printed allergen translation cards for where you are headed.
  • The Allergy Eats mobile app would work for allergies, sensitivities, celiac disease, etc. I may download this myself. Free.
  • Diabetics can check the American Diabetes Association’s website for a slew of information on travel safety and airport security policies, especially for traveling with syringes.
  • Tracey Neithercott has compiled a master list of 35 top tips for traveling with diabetes.  I especially like that she covers various modes of travel, not just air travel, and tackles issues like what happens if you are in the middle of the ocean on a cruise and you have an emergency event?  Or how do you keep your insulin cool when you are on a wilderness trek campout miles from electricity?
  • There is also a diabetes travel calculator site that is managed by the William Sansum Diabetes Center. Plug in your treatment, your travel details, and hit search – the site will give you specific advice based on your plans and medical needs.
  • Vegetarian or vegan?  Try the Veg Out app to find plant-based restaurants and resources while traveling. Vegan Express also seems to get great reviews, and includes grocery store purchases (great for traveling on a budget when you are sick of bananas and granola) and even alcohol.
  • For international travelers who are vegetarian or vegan, the Veg News travel section is full of country-specific tips.
  • Maya Shlayen at Gentle World gives us a beginner’s guide to traveling vegan. I especially like her tips on small packable products to bring that can make the sometimes-meager vegan fare more palatable.
  • Celiac, or gluten-sensitive?  The search site Find Me Gluten Free has you covered.  Also largely US-based.
  • Another search site, Healthy Dining Finder, lets you personalize a search for restaurants meeting your specific needs regarding things like sodium, fats, carbohydrates, protein, and calories. I can see this being great for travelers with cardiac conditions especially, since salt tends to sneak into many restaurant dishes.
  • Keep kosher on the road with Kosher Restaurants GPS. This app requires users to subscribe for a one-time cost of $18.
  • Kosher travelers may also find Totally Jewish Travel and Kosher Travel Info to be useful websites. Both allow searches, and both cover more than just food on the road.
  • Halal travelers also have helpful sites – Have Halal Will Travel is a comprehensive site that has both a halal food guide and a general halal travel guide. Halal Booking lets you plan and book a fully halal trip in one step. Halal Trip functions similarly but also includes some tools to help travelers meet their religious obligations as well.

Do you see anything I forgot?  Did I leave you and your situation out of this post accidentally?  Please let me know!  Head on over to my “Contact Me” page and send me an email, and I’ll see about doing some updating.

CPAP on the go: Travel smart with a CPAP machine

Traveling with a CPAP machine can be tricky, but there are simple ways to make it easier. While I wish I could just toss a few carefully chosen items into a Tom Bihn synapse 19 and go when I travel, I can’t safely leave my device at home. So, I have had to figure out how to be both travel savvy and medically compliant.

What is CPAP?

CPAP stands for “continuous positive airway pressure.” People with sleep apnea use them when they sleep to keep their airway open. Without one I snore like a dying rhino. My trachea is structured wrong – instead of being the usual circular tube, mine is an oval which collapses more easily. Without CPAP my airway closes like a straw pinched shut from suction, and my oxygen drops into the 60-something-percents while I sleep. This puts me at risk for problems like heart attack and stroke.

The fix is a CPAP machine, which is a machine about the size of a loaf of bread that generates a regular gust of air to keep my airway open.

How can CPAP complicate travel?

Two main ways:  roommates, and baggage.  Roommate-wise, if you are going to be sharing a room or crash space with someone who isn’t a partner (and thus isn’t used to the sounds of a CPAP machine), it can be an issue.  CPAP machines make a rhythmic blowing sound as the air is inhaled and then there is resistance and a pause in the sound during the exhale.  It isn’t loud, but for someone sensitive to noise it can be annoying.  If your mask slips during the night or you need to adjust it and break the seal, the sound of blowing is much louder and can wake a light sleeper.  Of course, these sounds are easier to tolerate than wall-rattling snoring that is common with apnea, but try telling that to an annoyed roommate who thinks you sound like a sketchy aquarium.

Baggage can also be an issue.  A standard CPAP machine isn’t huge but it isn’t tiny either.  Next month I am traveling on the cheap for ten days, and the flights booked allow for ONE eleven-pound bag.  ONE.  Not a purse plus carryon, or a carryon plus personal item.  Between the unit itself, the power cord, the air tube, and the mask, all in its padded carrying bag? It is fairly bulky and would use up maybe five pounds of my weight allotment – and maybe ALL of my ‘one bag’ allowance!

I say “maybe” because, officially, a CPAP is not supposed to count as a ‘bag’ for baggage allowance. With proper documentation it is a medical device. Not all carriers and screeners know this, though, and for this trip I decided it isn’t worth the fight.  Even if you do have an allowance that gives you a personal item plus carryon, theoretically allowing you a carryon PLUS a personal item PLUS your CPAP, juggling one extra bulky bag can be a pain.

Tips for better CPAP travel

Over time I’ve figured out a few things that make traveling with a CPAP easier.  Here are my tips for minimizing annoyance and complications while traveling with CPAP:

On the roommate issue
  • If at all possible, avoid sharing a room with someone you don’t know.  I find that dorm-style hostels, or shared hotel rooms for conferences or training programs where participants are paired by organizers, are awkward for me.  Often if I contact the organizer who does the pairing and explain the situation, they can assign a single room to me.  (Caveat: I have several medical conditions, not just apnea, which probably increases my success with this.  But it can’t hurt for you to ask.)
  • If you do have to share a room with someone you don’t know (or don’t know well), explain about the CPAP in advance rather than leaving them to wonder WTF as you unpack your device and start hooking up your tube to your mask.  Generally people are gracious, but if you have a difficult roommate the advance notice gives them enough time to request to be moved.
  • Bring two sets of earplugs.  One is for your roomate, and one is for you in case they complain loudly every time you stir and they realize again they can hear your machine.
On the baggage issue
  • Get a letter from your sleep doctor noting that the machine is a medical device that you need.  Sounds silly but it is crucial – if your doctor doesn’t offer to write one, ask.  Store the letter in the carrying case for the machine so that whenever you pack it up you have it automatically.  There’s no reason to take it out between trips, or for non-air-travel. With the letter from your sleep doctor letter, your device now is officially a medically necessary device purposes of travel.
  • Contact the airline or carrier and clarify their medical device policy.  Generally, a medical device won’t count as a bag, carryon, or personal device.  I’ve been stopped before for being over the carryon limit while carrying my CPAP bag, and one mention of ‘medical device’ shut the objection down immediately.  I was glad I had the letter on me though in case I had been challenged.  You can be asked to prove that the device is medically necessary and is yours.  I *could* press the carrier for my upcoming flight on their one-bag rule because of the letter and medical device policy, but I’m traveling internationally and if I’m delayed the stakes are high so I’m doing a workaround instead.
  • For travel where I have space or weight limits I carry my Z1 Travel CPAP machine.  I cannot recommend this machine enough!  It isn’t cheap – around $600, and the purchase wasn’t covered by insurance I already have a standard machine – but I decided it was worth it to not risk my only machine when traveling.  Also, the Z1 has an optional battery backup, making it perfect for those of us whose apnea is scary enough that a bad storm and power outage means being afraid to go to sleep at home.  There are some small possible downsides with the Z1 though:  no water reservoir (not an issue for me since I don’t use the humidifier function on my standard CPAP, but I could see how it would be bothersome if I were used to moist air), a shorter air hose for travel (good and bad, if you are a flailer you may come unattached and have to reconnect), and a little bit more noise from the unit itself.  I find the limitations minimal and the unit well worth it.  More information on the Z1 is here.  I was able to use flexible spending funds for my purchase, if you have a medical spending account check to see if it might be covered.
Two more tricks I wish someone had told me
  • Pack a small roll of medical tape, preferably silicon tape, in your CPAP bag.  If your mask or air tube cracks on the road, or your velcro mask attachment fails, you can do a makeshift airtight repair that will get you through until you can get a replacement.
  • Pack a large ziplock freezer bag and store your air hose in there during the day while you are out.  If you can’t do this, disconnect the hose from the body of the machine during the day and hang it over the closet door or over the shower curtain bar.  Before you hook the hose back up to the machine in the evening, put it up to your mouth and blow HARD three times.  Not to be icky, but the last thing you want is to discover there was a spider or bed bug or some other creepy crawly in the air tube by having it blown into your mouth or nose when you turn on the machine.  Don’t ask me how I know this.  :::shudder:::

Travel safe – and rested!

 

Photo credit: Ryan McGuire