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Travel

If you are planning an extended trip, it would be a good idea to discuss travel plans with your gastroenterologist or clinical team. Ask for a written summary of your condition that includes a list of your medications (generic and brand names), results of any recent investigations, and a management plan that informs you (or another doctor) what to do in the event of a flare-up.

Always take your doctors’ details with you, including contact numbers and e-mail addresses. If possible, see if your doctor can recommend an appropriate contact (name and phone numbers) in the areas that you will be visiting.

 

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IBD Travel Insurance

As the passport office states: ‘If you can’t afford travel insurance, you can’t afford to travel.’

Make sure to arrange travel insurance before you purchase your tickets. That way, if you happen to become ill prior to departure, your travel insurance should cover any cancellation fees. Be aware that not all insurance companies provide cover for pre-existing medical conditions and those that do still apply a number of exclusions or have excess charges and higher premiums. If you already have private health insurance, start with your own health fund to determine the level of cover you will have when you are out of the country. You might need to amend your current policy or look for alternatives that provide cover should you require medical treatment abroad or have to return to Australia for medical treatment before the scheduled end of your trip.

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Immunisation

You might need to obtain certain immunisations before you start your journey, depending on where you are planning to travel. It is best to discuss this with a travel-medicine specialist who can provide up-to-date requirements for your specific destinations. You should plan this consultation at least eight weeks prior to travel to allow time for vaccinations to take effect and to deal with any possible side effects before you leave.

Be sure to inform your travel-medicine specialist about all the medications that you are taking as some vaccinations (live vaccines) are not compatible with the medications used to treat IBD. It is not yet fully understood whether those taking medications that regulate or lower the immune response such as corticosteroids and azathioprine respond to live vaccines in the normal manner. In this situation, it is necessary to discuss the risks of stopping the medication versus those of not being vaccinated.

 

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Travelling and Accommodation

When travelling by air, see if it is possible to request an aisle seat close to the toilets, either when making your reservation or at some point closer to your departure date. Some airlines might charge an extra fee to make such arrangements for you.

If you have any dietary restrictions and will require a special in-flight meal, be sure to notify the airline or your travel agent well in advance.

Travelling by bus can be more challenging, and it is best to know beforehand whether or not the bus has an on-board toilet. If not, find out how many toilet stops the bus will make during the journey.

When travelling by car for an extended distance, plan your trip along major routes wherever possible as these are more likely to have a number of toilet facilities. For many larger cities, it is often possible to obtain information about toilet locations via the Internet.

It is also a good idea to bring a few rolls of toilet paper along with you just in case any of the facilities you use throughout your trip are out of paper. You should also consider bringing a small kit containing toilet paper, moistened wipes, or anything else that will help you during emergencies.

If you are planning to travel on a budget or visit places that are slightly off the beaten track, try to enquire in advance about the toilet facilities available at your accommodation. Even in major cities, it is not unusual for budget hotels and hostels to have shared bathrooms or to have facilities located on a floor other than the one your room is on.

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Medications

Where possible, take enough medication with you for the entire trip plus a little bit extra to cover for any delays. This should include regular maintenance medications, any medications required for flare-ups, and any appliances that you might need during that trip. Your doctor can write ‘REG24’ on a prescription which will allow you to pick up several months’ supply at once.

Current customs regulations restrict passengers from travelling with more than three months’ supply of medication. If you are planning to travel for longer than three months, you can obtain further information from the Australian Customs Service website at www.customs.gov.au

Medicare Australia also has an information line to answer your questions about travelling overseas with PBS medicines. The PBS Medicines enquiry line is 1800 500 147.

You can read about restrictions on www.humanservices.gov.au

Remember to keep your medications in their original containers and to bring along a copy of your prescription. This will allow Customs to confirm that the medications were indeed prescribed for you. Where possible, pack medications in your hand luggage to reduce the risk of loss or delay in transit. Note too that some non-prescription medications cannot be brought into some countries; have your doctor list these and check restrictions relating to the country of your destination.

Wherever and whenever you travel overseas, it is always a good idea to check the requirements of your destination countries regarding injectable prescription meds to avoid problems. For instance, Japan requires a special permit for travellers to bring in injectable drugs (which could include the biologics used for IBD). Consider checking requirements with the relevant embassies before you travel.

Current travel restrictions regarding hand luggage state that: ‘Containers of liquids, aerosols or gels in your carry-on baggage must be 100 millilitres or less. All containers must be sealed in a transparent, one-litre plastic bag. You are allowed only one plastic bag.’

Although prescribed medications are exempt from current hand-luggage restrictions, you will need to supply the appropriate documentation as discussed above.

Should you require any additional prescribed medications while you are away, be aware that you might not be able to get all your medications in some countries. You should check this out before you go, and ask your doctor or travel-medicine specialist for the names of any alternative medications if required.

Keep in mind that when travelling in other countries:

  • you might have to pay for the full cost of your medications, especially in a country that Australia does not have Reciprocal Health Care Agreements (RHCA) with
  • an RHCA country can still deny access to some medications, especially the expensive biologics
  • travel insurance is not going to cover routine supply of medications.

Some medications need to be permanently kept in a strictly controlled environment with a cool temperature. Check with your pharmacist whether any of your medications and/or supplies require special transport or storage arrangements.

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Food and Drink

Anyone who travels to an exotic location or developing country is at increased risk of experiencing travellers’ diarrhoea (gastroenteritis), an intestinal infection caused by bacteria, parasites, or viruses present in contaminated food or water. Taking measures to avoid this risk is especially important for those with ulcerative colitis or Crohn’s disease in order not to aggravate an already sensitive gastrointestinal tract.

The rule of thumb when travelling to exotic or developing countries is: ‘Boil it, peel it, or leave it!’

More specifically, some useful advice to follow while travelling is to:

  • avoid ice, fresh juices, iced tea and salads
  • avoid re-heated foods, uncooked foods such as shellfish, and any food from street vendors
  • choose only fruits and vegetables that you can peel yourself
  • drink only bottled or mineral water, or water that has been boiled or disinfected; use this water to brush your teeth and prepare food
  • be careful when consuming dairy products; boil unpasteurised milk
  • bear in mind that too much alcohol or spicy food can disturb normal digestion.

 

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What to do if Diarrhoea Hits

Despite taking all the best precautions, some people with IBD will develop gastroenteritis or experience a flare-up while travelling. It is important to identify if the diarrhoea has been caused by an infection or is a flare-up of disease.

Treating infective diarrhoea with the wrong medication such as corticosteroids could potentially make the condition worse. Generally speaking, if you get struck by a sudden onset of watery diarrhoea, most often accompanied by nausea, the probability is that you have caught a bug. In this situation, you should drink plenty of fluids. Re-hydration formulas can help to restore your electrolytes. At this stage, you should not take anti-diarrhoeal medications. The gut is trying to rid itself of the infection by irrigating itself.

Anti-diarrhoeal tablets slow the gut down which causes the bug to stay in the gut for longer. Symptoms should settle after 24-48 hours. If they persist, you should consult a doctor immediately.

On the other hand, a flare-up of IBD usually has a more gradual onset. If you are able to identify the onset of a flare-up, you should follow the management plan recommended by your gastroenterologist.

Should you develop any of the following symptoms whilst travelling, you must get medical attention immediately:

  • high fever, shaking and chills
  • profuse bloody diarrhoea
  • severe abdominal pain and/or distension
  • fainting, dizziness, and concentrated or reduced urine.

Many doctors recommend that you travel with a course of antibiotics such as metronidazole. Antibiotics can be used to treat infection and, in some cases, treat a flare-up of IBD symptoms.

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Other Sources of Information

Some useful travel health websites that you can visit for further information include:

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Bon Voyage!

There is no doubt that IBD presents a number of challenges for anyone wishing to travel. But the key to success lies in the preparation. The advice and recommendations provided here can help ensure that your travels are as enjoyable and event-free as possible. Above all, have a great trip!

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