It's OK if you just make them anyway, because I sure did
I chose death (curried pilaf). Yurei Izakaya, a ghost-themed restaurant in Kichijoji, Japan. © 2015 Katie McLendon
Stepping onto the streets of Tokyo for the first time four weeks ago was like walking into The Lego Movie’s “Everything is Awesome!” sequence, and I mean that in the best way possible. Everything was awesome in Japan. Seeing the wild snow macaques in person that I’ve been watching in nature specials for decades blew my mind and exploded my heart. I just spent 11 amazing days in Tokyo, Kyoto and the Japan Alps, and I can’t shut up about it. At some construction sites, they use Hello Kitty barriers; look!
Outside Shinjuku Station, Tokyo. © 2015 Katie McLendon
But healthwise, some things were not awesome, like jetlag and constipation. And my adrenaline-fueled legs, which complaintlessly propelled me and my suitcases up and down countless flights of train-station stairs for more than a week, suddenly dumped all the built-up pain and exhaustion on me when I hit American soil and the spell was broken.
This is not my first international trip, so you’d think I maybe would’ve learned more lessons from before and shrewdly applied them all this time. I once spent 6 weeks on a research trip in the rural Caribbean; four major medical issues cropped up, and I had to fly back to get a dose of Cimzia). And in Saint Lucia, I ran out of medication and flared hard while on an all-inclusive resort (which did NOT include medical care, unfortunately). But I’ve found there are plenty of health-related travel mistakes to last a lifetime, all around the world.
Japan has excellent medical care and sanitation, so I didn’t have to worry about needing to be medevac-ed out with a blockage or contracting an exotic stomach bug (a key upside for Japan as a destination). But any international long-term travel comes with its own set of challenges, some of which apply over country lines and some of which don’t. Here are the lessons I (hopefully, this time) learned:
Note: The tips from my non-overseas travel post still apply for the most part, as does the warning that international travel for chronically ill people requires way more preparation than any internet post can provide. You should ask your doctor about any vaccines or travel clinic consultations you need. And you can also check the CDC Travelers Health website for tips on what you might need to do in advance or while abroad to help you stay healthy.
Screen shot from SeatGuru.com.
1. Seats. Overseas flights are long flights, so get decent seats. This isn’t always the same thing as expensive seats (unless you’re talking about first class, in which case down comforters, deep-space-mission sleeping pods and diamond-encrusted hot fudge sundaes absolutely does mean good seats), and it doesn’t always mean the same thing for everyone.
Go on SeatGuru and enter your flight info, and it will give you ratings and specs for your seats. I will say that the bulkhead extended-legroom seats are great for your legs (we had them coming and going to/from Tokyo) and people with IBD or on certain medications can have a higher risk of blood clots if sitting still for long periods. But the non-legs parts of my body didn't really like it. You usually don’t have a seat to stow one of your bags under, which can be annoying if you need to get out more snacks or different reading/watching material out of the overhead bin, and you’re trying to do this without bringing heavy luggage smashing down onto sleeping fellow passengers. It can also be annoying to be in these seats if they’re near the bathrooms, which they often are (also the designated stretching/yoga-posing/new-friend-making/bored-staring-at-me spot, apparently). But if you have a tendency toward urgent diarrhea and seconds can sometimes count, the annoyance could be worth it.
2. Meds. Pre-bag your (non-narcotic) meds by dose, and keep them in your carry-on with a note from your doctor, and possibly also the bottles or labels. Do this a week before your trip, or you will run out of time the night before and tell yourself it’s unnecessary (yeah, that was me). The little bag will go in your pocket every morning and you'll actually take them, instead of rushing out the door in excitement for the temples and ghost cafes on your itinerary (or to catch the next train, which will almost certainly be right on time).
For bedtime doses, it’s usually easier to remember to take them since you’re back at the hotel, but in a puddle of exhaustion and sake you might talk yourself into closing your eyes and lying down for just a second … . A little baggie with your nightly dose in it takes some resistance and thought out of it when you’re dead tired.
Bring over-the-counter meds, too, even if you don’t take them every day. It's obviously hard to read the labels of another language, even if you have some basic skills in the language (and if you’re having to read the labels of medications, you’re probably not at your best, so it’s better to not have to). So, if you every once in a while need Miralax, Lomotil, anti-spasmodics, and so on, then pack them (in your carry-on!), and pack a little more than you think you’d need. I ended up throwing out my excess OTC meds near the end of the trip to cram in more Ghibli Museum gift shop souvenirs, but it was good to have it there.
3. Luggage. We had several requests for Japanese swords as souvenirs, and I knew I'd want to buy everything I saw, so I took an enormous near-empty suitcase -- it came up to my chest. This turned out to be a significant inconvenience -- in our teeny tiny hotel room, and on rush-hour trains. Besides what you need for health and comfort, pack light going there, and either bring an empty duffel bag or folded-up cardboard box to fill with souvenirs at the end of your trip (and then check it at the airport, or ship it back to yourself through your hotel. It's so much harder to zip around on the JR trains when you've got more bags than limbs. There are also luggage-delivery services to many hotels, but there can be significant delays in how fast they'll arrive.
4. Sleep. Pack a good travel neck pillow (again, different for everyone, but browse reviews on Amazon), eye mask, and sleep headphones, and make yourself try to sleep at every opportunity (my strategy: listen to boring podcasts you've heard before, or nature sounds). OK, my actual strategy was to lose consciousness as soon as I hit the headrest on the flight home, punchily watch a Pixar movie, then scarf down gluten-free biscuits from our hotel room service that I stashed in a (clean! unused! from a fancy hotel!) plastic laundry bag. The bag also served as a great crumb-catcher. I didn't know how to find Ziploc bags. Shut up.
5. Food to pack. Bring lots of snacks from home. Yes, part of the adventure of traveling is trying new things, but it can lead to a little too much "adventure" for those of us with IBD if we don't calculate our risks well. If you start to feel sick, your gut will crave familiarity. Even if not, your gut may get a little homesick anyway, so bring a stash of bars and chips. I'm a breakfast girl, so I regretted not bringing instant-oatmeal packets for when rural restaurants weren't open for breakfast, but those Park Hyatt rice-flour biscuits, and quinoa with rice milk and bananas, made up for it. If you're lucky, your hotel will have a breakfast buffet (or your ryokan may offer meal service), and this often includes rice porridge, eggs, fruit and pastries.
6. Itinerary. Don't change hotels too much, and try to build in flexibility for, if not rest days, then long-haul-travel-free days. Have a list of must-dos separate from want-to-dos. Everything takes longer than you think it will, because you will get lost or get on the wrong train or have to spend 45 minutes in the bathroom because you went three days without being able to go and now whoa. But don't worry, because it will probably feel like you were in Japan for twice as long as you actually were, from the extreme novelty of it all. You'll find that you're not just nostalgic for the big-ticket items like sumo shows and hanging out with snow monkeys, but also just riding the train while eating from a bento box, buying novelty socks, and using the ATM at 7/11.
Wild snow monkeys of Jigokudani Yaen-koen. They really get this close to you. © 2015 Katie McLendon
7. Meals. Request special meals from the airline as soon as possible, if you need them. Bonus beyond eating more safely: You probably will get fed before everyone else on the plane (except for first class, of course), and the food is often better than normal airplane meals or snacks. I had chicken breast with quinoa, and salmon with steamed vegetables, with a gluten-/dairy-/egg-free shortbread cookie or muffin. At hotels and restaurants, don't assume they can't accommodate you -- I was thrillingly surprised by rice-flour biscuits and red-bean-topped sweet-rice dumpling desserts (and even canned Suntory whiskey and club soda highballs in vending machines!) that fit into my diet. But also, sometimes you just have to order by picture, so do your best and take some digestive enzymes or whatever you typically do to make iffy food go better, and try not to worry too much about what can’t be helped.
8. Money. You don’t want to end up having to skip a meal (or eat out of a mysterious vending machine -- although I do recommend that for those who can) because you don’t have the cash you need to buy healthy and safe food. I was surprised to hear (and experience) that even Tokyo is super-cash-based, and then I was quickly loaded down with change in coins that ranged in value from about $4 USD to less than a penny. They have a lot of coins.
9. Wifi. It’s so important. Just in general, but also for researching restaurants, attractions, walking directions, phone numbers, urgent-care clinics, etc. If possible, arrange for a mobile wifi router to be pre-delivered to your first hotel, and then you can ask your last hotel at checkout to ship it back to the wifi company in the prepaid envelope. Yes! It’s awesome. Just don't forget to charge the router every chance you get (tip: some trains include power outlets).
10. Health care. Before you leave, look up medical clinics for English-speaking foreigners, plus know how to ask in Japanese for an English-speaking doctor or hospital or translator (they're gonna know you're speaking English, but just in case). Which leads us to …
This pretty much sums up our trip. Hachiko statue, at Shibuya Station/Shibuya Crossing. © 2015 Katie McLendon
11. Language. Learn how to say:
Even when you say something you think is in the local language, you may be met with a confused but apologetic look and nervous laughter, or just outright laughter (as a cop gave me outside of the Ghibli Museum), so have a thick skin and sense of humor (or go vent or cry privately, into a Suntory highball).
12. Destination: As mentioned above, Japan has the benefit of being both exotic (at least to Westerners) and relatively safe for travel with IBD and on immune suppressants, at least compared to many other possible destinations. Think about what you want out of your trip and what your gut needs, and try to make those overlap as much as possible. Don’t assume that you “can’t go anywhere because of my Crohn’s” (pout), but also don’t assume that you’ll be able to get a fresh ice pack for your Humira syringe on the Jeep ride into the Amazon rainforest. And while we’re talking about assuming …
Shinjuku, a nightlife-heavy neighborhood of Tokyo. © 2015 Katie McLendon
13. Don’t assume … that there will be:
Don’t assume that you’ll take your meds just because you always do and you know how important it is. Or that you’ll stay on a sensible diet because the local diet is mostly rice and fish (there's plenty else here to tempt you. Like dozens of different Kit Kat flavors, or special Halloween cakes at department stores). Or that you'll just figure out how to get a prescription medication if it turns out you need it.
And don’t assume that you’re a failure if you do none of these things right; you can still have an amazing trip while your gut is busy hating you. People without chronic diseases get sick while traveling, too; sometimes it can't be avoided.
But as much as you can, come reasonably prepared and be careful, so instead of frantically searching for Japanese laxatives, you can focus on snow monkeys and whiskey and yakitori bars … or on frantically trying to purchase and pack five souvenir samurai swords.