Travel with Ulcerative Colitis: Peru

Enjoying the Incan ruins of Pisac.

Thinking about my disease isn't always something I like to do when I’m feeling well, so consider my lack of posts a good sign. However, today I want to talk about my two-week study abroad and service trip to Peru—which went perfectly well…for the most part. Luckily, my Ulcerative Colitis has remained in remission, and my travels abroad went great. I’ll share some of my travel tips and what I did to prepare for the trip medically, as well as the diet that I followed in order to minimize my chances of bacterial infection.

Preparation and Meds

Florastor, the probiotic I took before and during the trip.

I was nervous about going to Peru, especially since my first signs of UC appeared after a trip to Mexico almost three years ago. I made an appointment with my GI to get her opinion before the trip. I was prescribed both Flagyl and Cipro to take with me in case I picked up a bacterial infection, and I also brought the Prednisone that I already had in case of a flare up. My usual Remicade treatment (every 6 weeks) was administered about two weeks before the trip. When I asked if I should take a probiotic as an extra precaution, my GI told me that I could take the probiotic Florastor, as well and Curcumin, the natural anti-inflammatory derived from turmeric. I began taking both of these morning and night a few days before the trip, in order to prepare my gut for the new environment and bacteria it would be exposed to. After packing a load of hand sanitizer, tissues, and wet wipes, I was ready to go. I also brought along some Allegra for my allergies (which came in very handy—my nose was running like crazy some days because of the altitude) and some Tylenol in case of a cold. My suitcase was locked and loaded with meds—you can never be too careful.

Diet

I was warned about potential altitude sickness upon arrival in Cusco at 11,000 ft., although I never had any problems with it. For altitude sickness, my professors recommended coca tea, made from the leaves of the coca plant—the same plant that cocaine is derived from. I tried it a couple times and it didn’t have any effect on my UC at all, so I would recommend it. The dry air of the plane ride and the mountain air made my throat feel extremely dry, so I drank a huge amount of tea throughout the whole trip to help stay hydrated. After dinner with my host family, I would regularly drink 4 or 5 cups of tea. I typically drank anis (annis) and manzanilla (chamomile), which my roommate and I mistakenly believed was a clever moniker for a mixture between apple (manzana) and vanilla (vainilla) for most of the trip. We obviously have no sense of taste.

When it came to eating throughout the trip, I was a strict germophobe—I brought hand sanitizer and Wet Ones everywhere. Aside from religious hand-washing, there are some basic rules I followed when eating in Peru:

1.       DO NOT DRINK THE WATER—Bottled, boiled, or filtered water only. Seriously. Do not even brush your teeth with the tap water. Order drinks without ice, or order a bottled drink that you know is safe, like soda.

2.      Cooked vegetables only—Salads are out of the question, and if you eat any sort of raw fruit or vegetable it should be one with a thick skin and be washed in water with bleach. Peruvian diet is very carb-heavy, which was fine by me.

3.       Meats should be fully cooked—Obviously.

4.       Do NOT eat the street food—I don’t care if it smells good. Don’t even think about it. Bring snacks instead; I brought a bunch of Cliff bars and other protein bars along with me.

Really, just use common sense and be aware of what you’re eating. Other than that, I didn’t follow a special diet. The coolest thing I was able to taste was an alpaca steak, which was actually really delicious and reminded me of veal.

Food Poisoning

Guinea pig, a Peruvian delicacy known as cuy.

I believe that foodborne illness could have been avoided completely if not for the fact that this was partly a service trip. On the penultimate day of the trip, I built stoves from clay and mud in one of the local villages. Although I used gloves the entire time, this mud is full of guinea pig feces and who knows what else—really not something you want to be exposed to if you've got a weak immune system. After stripping the gloves off

after work, I used a whole package of wet wipes on my hands and arms, plus a load of hand sanitizer. There wasn't a sink available in the village, since it was quite a rural area, and we had to eat our lunch on the bus after work. I was tempted to refrain from lunch until we returned to a place where I could wash up, but I was starving so I ate just a little to hold me over. Lesson learned: nothing beats soap and water.

That night, after I went to sleep, I woke up feeling very bad—extremely hot, almost feverish, and generally uncomfortable. I tried to roll over and sleep it off, but I couldn't fall back asleep and I ended up feeling increasingly worse. I felt nauseated and went to the bathroom. I had diarrhea and was feeling lightheaded, along with that sensation that accompanies nausea where your vision goes white around the edges. I was a little worried that I was going to pass out, but after vomiting rather violently into the trash can, I felt significantly better. I thought it was over then, and was actually able to go back to sleep, but I woke up feeling awful again three more times throughout the night and in the morning. It was the same pattern; I’d feel terrible and then after throwing up I would feel exponentially better. And repeat. The vomiting stopped that next morning, but I spent most of the next two days in bed, drinking Gatorade and a “rehydration powder” mixed with water that my host family brought me. I was able to eat some soup, but really had no appetite at all. The diarrhea lasted for four or five more days, even after I started eating solid foods. While this was all very unpleasant, it—needless to say—doesn't even hold a candle to UC. It was the UC that really worried me.

To Medicate, or Not to Medicate?

I became even more nervous when I found out that I wasn't the only one to get sick that day. A friend of mine fell ill the same night, with the same symptoms down to the timing, and he tested positive for salmonella. After hearing that, I was really nervous that I had it too, but I didn't want to go to the clinic and risk exposure to other bacteria or viruses. I was scared that whatever I had ingested would set off a flare of my UC—like C. diff had in the past. My GI told me that if the diarrhea didn't go away in a few days, I could start taking the Flagyl. I really wanted to avoid antibiotics, since they’d wipe out all the beneficial gut flora along with the bad, so I decided to cautiously wait it out—and I’m glad I did. After about 5 days, my stools suddenly returned to normal and now I’m back at 100% and still in remission, no antibiotics needed! So luckily my little bout of food poisoning passed without too much trouble.

Despite the little bump in the road, my trip went really great overall and I was able to see some amazing sights. So if you have UC, don’t let your fears of a flare up stop you from travelling. Another article that I found to be helpful before my trip was this one: http://www.ihaveuc.com/traveling-and-the-scd-diet/, from a guy with UC who also went to Peru for two weeks! His story made me feel better about traveling, and I hope that sharing mine will help someone else.

Ancient Incan terraces of Moray in Peru. 

Self-Esteem and IBD

When you have Inflammatory Bowel Disease, you’re forced to deal with a lot of crap—literally and figuratively. Not only are people affected by disease symptoms, but the side effects of certain treatments. The ulceration in your colon might not visible to others, but side effects often do have physical manifestations. Sometimes your self-esteem can take a hit when struggling with side effects like weight loss, weight gain, facial swelling, and acne.

Edema

Dehydration and malnutrition often cause rapid weight loss during a flare. It’s hard enough to keep things down (and keep them in), and when you’re running to the bathroom fifteen to twenty (or more) times a day, fluid and nutrition is easily lost. An IV is the best remedy for dehydration, but, if the body also lacks protein, edema can occur. Edema is the phenomenon of swelling due to fluid retention. So after a drastic drop in your weight, you could find yourself swelling up like a balloon.

Photo via Keck Medicine at the University of Southern California

   

The edema is harder on the body than you’d imagine. When you’re lying in a hospital bed all day with little to no energy, your muscles will dwindle. This makes the swelling feel a lot heavier, making it that much more difficult to get out of bed. It can even cause back pain due to the pressure the swelling causes. I felt like lopsided water-balloon animal; my forearms were larger than my upper arms, and my feet and ankles were puffy. It was a strange sight.

Weight loss

Without an IV, the fluid weight is usually lost within a couple weeks. However, this will bring you back to the equally unpleasant state of being underweight, which is not glamorous in the slightest. I try to gain weight as quickly as possible, but it’s a slow process. It takes me months to get back to my normal weight, and the transition period can be awkward and uncomfortable. I’ve felt discouraged from going out anywhere—even when I do have the energy—because I don’t want to be seen in my withered state. I basically looked like Sirius Black after escaping Azkaban, but not as cool as Gary Oldman.

Moon Face and Acne Rash

On top of the weight fluctuation, the standard treatment to get a flare back under control involves the use of steroids, which come with a load of side effects. As I mentioned in a previous post, a common side-effect of the steroid Prednisone is facial acne, which won’t go away until you’re off the medicine completely. I despise the acne rash, and covering it up with make-up is tedious and only somewhat effective. I imagine most men with prednisone acne probably won’t be slathering cover-up on their face, which leaves them with even fewer options to cope. Along with the red bumps that appear all over the forehead, cheeks, chin, and chest, Prednisone will also cause facial swelling. Some people deal with a rather severe “moon-face.” For me, the swelling is minimal, but definitely noticeable.

Moon Face vs. Normal Face

Yep, that is me on the left, not a chipmunk. As you can see, Prednisone can really make your cheeks puff up. 

All of these side effects can make it difficult for a person to feel confident and happy about themselves, which is important during the recovery process. You don’t feel like going out, but too much reclusiveness can be detrimental as well. If you get hung up on the temporary state of your body, you just make the recovery process even harder for yourself. Even if I don’t feel back at 100%, I try to remind myself that in time I’ll be in a better place, physically and mentally.

TIPS:

• One thing that helps boost my self-esteem during the recovery process is exercise. Go for a walk, run, or just lift some weights at home—you will start to build back your muscles and feel better in general. 
• If you are insecure about being underweight, wear loose clothing. Baggy clothes will make things less noticeable, and odds are strangers probably won’t take any notice anyway—it’s only a big deal to you.
•  Most importantly, do something that makes you happy! Draw, write, play games, or watch some movies—not everything has to be exertional if you are low on energy.

Changes in your appearance always seem more drastic to you because you’re more familiar with your body than anyone else. Sometimes it’s best not to care. You don’t need the stress.

I hope all the other UC warriors out there feel better and stay happy.