Summers are a time to look forward to rest, relaxation, and vacations. But for those of us living with inflammatory bowel disease (IBD), going away on a trip can often mean additional anxiety. And with the addition of COVID-19, anxiety levels are heightened. While many of us want to travel, we struggle to wrap our heads around how to travel when living with Crohn’s disease or ulcerative colitis, especially as new variants of the novel coronavirus circulate around the world.
In fact, stressing out over travel may worsen symptoms. A study published in Current Pharmaceutical Design in 2017 found that stress and anxiety can increase the severity of inflammatory bowel disease by negatively influencing the “brain-gut axis.” A more recent study, from June 2021, in Digestive Diseases and Sciences indicated that IBD patients feel significantly more vulnerable to COVID-19, which has “increased overall illness-related anxiety.”
As a patient advocate who is personally affected by Crohn’s disease, among other immune-mediated inflammatory diagnoses, I often travel to speak at conferences and events. I am always worried about getting sick during travel, and I keep an open dialogue with my care team so I know how to best prepare and keep myself safe.
In today’s climate, even though the coronavirus is still at large, traveling is a very personal decision and based on comfort level. But it's important to remember that we can and should try to do the activities that make us happy, traveling included. Whether that means day trips to a nearby city, beach, or mountain, or even short weekend trips by car, traveling is whatever we define it to be and whatever we might feel comfortable with at any given moment.
So, how can we make the most of travel without getting caught up in worries about how our health will fare during our vacations? Below are some of my go-to hacks for when I’m getting ready to jet away.
1. Clear Travel With Your Gastroenterologist or Colorectal Surgeon
Whether you’re stable, just out of a flare-up, or recovering from surgery or even COVID-19, I recommend speaking to your doctor about reasonable travel expectations, whether you're considering a day trip, a weekend trip, or a longer excursion.
Doctors can provide guidance on what medications to pack, what vaccinations to get beforehand (if necessary) and what kind of diet to maintain while traveling.
Recently, I was getting ready for Digestive Disease Week in San Diego, and my husband fell sick with COVID. Even though I was worried about him and my own exposure, my doctor suggested that I stick to my travel plans as long as I continued to test negative. He also assured me that he would help me get access to an antiviral if I fell ill while traveling. That eased my anxiety significantly, and I was able to go to San Diego wearing my N95 mask without any issues. That settled game plan eased my anxiety and reduced my stress.
Similarly, after a recent out-of-state surgery in November 2021, I had to travel home to New York. My gastroenterologist in Pittsburgh advised me not to fly, because the omicron variant was rampant and I was on high doses of steroids at the time. Instead, my husband and I drove home, stopping every two hours so I could stretch and walk and eat small bites of food as well as use the facilities.
2. Use a Packing List, and Always Pack Extra
I’ve found that keeping an ongoing packing list that I can add to, edit, and revise several days in advance of my trip helps me feel prepared.
A few things that are always on my list:
- Extra masks (both surgical and N95)
- Extra rapid tests
- Hand sanitizer
- Disinfectant wipes to wipe down seats and tables on trains, planes, and buses.
- Snacks that are gut-friendly (whatever that means for you)
- Extra underwear
- Ostomy supplies
- Oral solutions like DripDrop or Liquid IV to prevent dehydration
- Insect repellent
- Extra medications
- Pillbox to organize daily and as-needed medications for travel
- Probiotics to prevent traveler’s diarrhea
When traveling with injectable medications, I recommend packing them with ice packs and keeping a doctor’s note on hand. A flight attendant will sometimes put biological medications in a fridge for you, especially on international flights. Lastly, because of my compromised immune system and history of allergies and sinusitis, I typically bring the cold and sinus medications that I know work best for me, especially when traveling out of the country, where the same medications may not be available.
3. Research IBD Centers and COVID Testing Sites Close to Your Destination
If I’m traveling to a major city, I usually don’t worry too much about this; but if I’m going to a more remote destination, I like to know which hospitals can handle my care should I get sick.
The other thing to note when traveling abroad is that it’s very important to know nearby hospitals that understand and can treat IBD. I like to learn generic names of medications in advance of foreign trips, because many locations use generic names rather than branded ones.
With regard to COVID-19, I also suggest looking up airline rules and COVID testing sites in advance of travel, particularly international travel, to understand what is required to get in and out of that country as safely and as efficiently as possible.
4. Look Up Restaurants and Their Menus Ahead of Time
Before traveling to a new place, I like to take time to map out a constellation of restaurants in my phone map in the vicinity of where I’m staying or visiting.
Since I’m a vegetarian, I like to use the HappyCow app to locate restaurants, and I often make reservations using the OpenTable app or, if abroad, TheFork app, so I can be sure to have vegetarian options. I also try to learn the local words for vegetarian, vegan, gluten-free/celiac, well-done/well-cooked, etc.
In the pandemic era, I tend to call restaurants in advance to check if they have outdoor dining. Again, this depends on one’s comfort level, but I generally prefer to dine outdoors, especially in crowded cities where restaurants may be bustling.
5. Familiarize Yourself With Bathroom Locations
In most metropolitan cities, public restrooms are relatively accessible, and most places will honor a restroom necessity card. If you know some of the buildings and places you’ll be visiting, it can be helpful to look up restrooms ahead of time.
A few apps are great for locating bathrooms. For example, the Crohn’s & Colitis Foundation has a new app in the United States called We Can’t Wait, which has helped me countless times even in my home city when I’m out and about with my friends. Crohn’s & Colitis Canada has a similar app called GoHere Washroom Locator for those traveling to or living in Canada.
6. Yes, Buy Travel Insurance, Just in Case
A lesson I’ve learned the hard way: Always buy travel insurance. Too many times, illness has prevented me from traveling. Travel insurance gives me peace of mind, knowing that the money I spent won’t be forfeited. For domestic travel, I usually buy insurance through Allianz; for international travel, I like to use HTH Travel Insurance. HTH provides coverage for preexisting conditions as long as the plan is purchased in advance of the trip. It even has health insurance policies for students who are studying abroad.
I also check to make sure there is COVID coverage on insurance plans so if I do contract the virus, I can cancel the trip in advance or get the help I need while traveling.
7. Be Mindful of Germs and the Risk of Infections on Flights, Buses, and Trains
Two and a half years ago, a plane ride exposed me to a life-threatening strain of the influenza A virus.
Since that experience, my doctor now recommends that I always wear a mask when traveling and wipe down seats, armrests, and the tray in front of me with antibacterial wipes.
In my mind, this is of even greater importance now with COVID-19, and I always wear a mask, wipe everything in my vicinity, and wash my hands or use hand sanitizer when I board a flight, bus, or train.
On the same note, it is also important to remember not to travel if you have or may have any virus, so as not to spread disease. Just as we would want that courtesy extended to us, we should do the same for others who may be struggling to travel and enjoy their lives in spite of chronic illness.
In a world where COVID is now evolving from pandemic to endemic status, it’s important to equip ourselves to live our lives again in spite of our chronic illnesses and the viruses looming around us. It has done wonders for my mental health to start traveling again, speak at conferences again, and spend time with loved ones again, and I would love to see my fellow IBD warriors do the same.
So, own your Crohn’s, own your IBD, and take on the challenge of traveling within your own comfort level. No matter how daunting it may feel beforehand, with some preparation travel is possible, and you too can live a full life with inflammatory bowel disease.