Friday, February 16, 2018

The Road Less Travelled

As a kid, I travelled with my family was all about the exhilaration of flying and the excitement of our final destination. I knew nothing of the logistics and planning that went into even a short trip. When I began travelling without my parents as a teenager and young adult, I found the experience quite stressful at first. But over the years, as I've logged more and more trips, my skills have improved and I've developed routines and strategies that have made travel as painless as possible.

As an adult, travel is an important aspect of my career. I don't travel constantly, but I do travel regularly. I live with several conditions that make travel more challenging than it might be for most people. The fact that I'm legally blind is, to outward appearances, what would seem to interefere most with travel. But it's actually the easiest thing to deal with. As long as I have a good travel itinerary, store important information in an accessible and non-digital format, and am not afraid to ask for assistance navigating through airports and hotels when needed, it's a non-issue. The only other considerations I make for my vision are to ensure that my various devices (iPad, BrailleNote) are charged up before a flight, since neither the on-board entertainment systems nor print materials are accessable, ensuring I bring earbuds, and (for really long trips) bringing a backup white cane.

The chronic conditions I live with pose a far greater challenge on me than my level of vision. Type 1 diabetes brings with it a heap of medical peraphernalia; severe food allergies (and eating a low-carb diet to manage my diabetes) makes eating when travelling a major challenge; and severe environmental allergies, asthma, and eczema mean that I have to be careful with what I'm exposed to on airplanes and in hotels, and during daily life in general. Over the years I've found strategies that have helped me deal with each of these factors.

Packing:

First up when going on any trip is packing. Ensuring that I don't forget anything is extremely important and probably the most stressful part of the trip for me. Having been stranded with insulin but no pen needles, a failed continuous glucose monitor (CGM) sensor and no test strips, spending hours in an airport without any food to eat, or having my insulin pump alarm that the battery is low when I have no replacement on hand are not experiences I'd like to repeat.

A backed suitcase with packing cube, allergy cover, toiletry bag, and Pack-It cooler

I use packing cubes both to keep my suitcase organized and to fit more into my suitcase than I'd otherwise be able to. I have a set of four packing cubes, a garmet folder, a toiletry bag, and various other kits that keep everything contained and tidy. I have a suitcase, a carry-on bag that attaches to the suitcase's handle (important so that I can comfortably roll both while keeping one hand free to use my cane), and my usual, everyday backpack, which is usually what I bring as carry-on luggage. I always bring double the medical supplies that I'll need for a trip, and I always pack the medical supplies in my carry-on luggage. For long trips where I've had an entire bag of insulin pump and other medical supplies, most airlines will permit a bag containing only medical supplies as a second carry-on item.

Travel:

Two bags of medication, one clear containing liquid medications such as EpiPens, a glucagon kit, insulin, eye drops, and creams, and the other blue containing other medications
Once I get to the airport, I usually ask for assistance through security and to the gate because it's the quickest and easiest method for me to get there. I always separate my medication into a clear "liquids" bag and a bright blue "solids" bag. I once left an entire bag of pump supplies at security after they took it out to inspect, and didn't realize until I was at home. Ever since then, I've put my medical supplies in a highly-visible coloured bag. I always declare to security that I'm wearing an insulin pump and continuous glucose montior, and have both clipped to my pockets fully visible. I have a doctor's note stating that I have severe food allergies and Type 1 diabetes and need to keep my medical supplies with me at all times,in case anyone tried to take them away, but I've never needed to use this. Invariably I set off the metal detector and need a pat-donw, so I always leave extra time for getting through security. Frequently my BrailleNote is a cause of suspicion and needs to be swabbed, too.

I pre-board the plane because of my visual impairment, but people with severe food allergies are permitted to do this, too, if they ask. Since I'm not allergic to nuts or peanuts, airlines don't provie a buffer zone. I've experienced three allergic reactions while on board a plane (fortunately none were severe, though one was getting to a scary stage), and countless high and low blood sugar episodes. So it's essential that I'm as prepared as possible. When I get on board, I wipe down the arm rests, seatbelt, and tray table (I use Wet Ones Sensitive Skin) to hopefully remove any allergens and get out what I jokingly call my "utility belt", which I've stocked while waiting at the gate.

A Spibelt holding an EpiPen, rescue inhaler, and tube of glucose tablets
My "utility belt" is a double pocket SPI-BELT that fits an EpiPen, a tube of glucose tablets, an inhaler, and if needed can also fit a second EpiPen (or a glucagon kit), glucose gel, and a small GoTubb container containing medication like Benadryl and Advil. I clip my Dexcom receiver to the belt so it's easily accessible, and of course my pump is always clipped nearby as well. I always bring my own safe, low-carb snacks and meals with me (containing no liquids) and never eat meals provided by the airline. If my backpack ends up being stored in an overhead compartment, I have a bag available where I can store my food, entertainment devices, cane, and glucose meter under my seat. I don't currently bring a mask on flights, but having reacted to both food people next to me were eating and cat and dog dander on flights in the past, I will likely get this Respro allergy mask and bring it with me just in case I end up sitting beside someone with a cat (also for use when cleaning and during horrible wildfire summers).

Hotel:

Once the flight is over and I've found my way to the hotel, I set up the room in a way that works for me. I have a twin sized Allersac, basically a portable dust mite cover, that I put on the bed. If needed, I call the front desk and request non-feather pillows. I disregard the hotel soap, shampoo, and conditioner in favour of my own versions that I've brought in GoToob containers, which won't aggravate my eczema. (If travelling to colder climates, I've also learned that it's important to pre-test hats and gloves, something I discovered on a recent trip to an area with -25°C weather where the toque and gloves I'd brought, which I hadn't worn in a long time, made my skin feel like it was sunburnt and break out in a rash.) I also put food I've brought in my checked luggage into the hotel fridge. I never put insulin or other medication in there due to the risk of freezing it by accident. If I'm travelling to a hot location where medication may overheat, I put it in one of several Frio cooling pouches that I've bought over the years.

Food:

Eeating with both severe food allergies and a low-carb diet for diabetes is a major part of my travel preparations. I have two Pack-It lunch bags, a snack sized one and a deluxe sized one, that I use to bring food that requires refrigeration with me. I put food that doesn't require refrigeration in a small packing cube. I bring all food, plus the freezable lunch bags, in my checked luggage, not in my carry-on luggage as there may be restrictions around liquids and ice packs with carry-on luggage. It's important to check and follow any prohibitions around food if crossing international borders. I bring other helpful supplies, including a small cutting board, a set of utensils (with only a table knife, no sharp knives, and ensuring they are declared to customs if travelling across a border), Tupperware containers (regular ones and collapsible ones), paper towels and plastic bags, and a small container of dish soap. I've also recently purchased a small collapsible travel kettle, because many hotel rooms these days only have Keurig machines, and water from them tastes foul. When travelling through customs, I find it very helpful to type up a list of all food that I'm bringing with a note at the top stating that I'm bringing so much food due to severe food allergies and Type 1 diabetes. I've always handed over the note and had no problems whatsoever, which makes for a stress-free experience.

A small hotel fridge stocked full of low-carb, allergy-friendly food
Depending on the type of trip I'm going on, I eat anywhere from 75% to 100% of my meals from the food I've brought. I often get a cab or a ride to a nearby grocery store to buy some fresh vegetables. But other staples, like bread, yogurt, salad dressing, and so on I often can't find in allergy-safe and/or low-carb versions, so bring my own. I've mastered the art of living out of a hotel room with only a fridge and microwave (or, once, only a fridge) for up to ten days. I sometimes eat at restaurants, particularly at dinner, but my meal selection is very limited and the risk of cross-contamination high, so I often don't really enjoy the experience nearly as much as the colleagues or friends I'm eating with. When I do eat out, I find food allergy cards handy so that I don't have to announce in front of colleagues what feels like half my medical history. If I'm uncomfortable with the restaurant, I'll go to socialize or network but decline to eat and fill up once I get back to my hotel room.

My final preparations are that I always wear my MedicAlert bracelet. I pick that brand in particular because it has emergency contact information on file. I also frequently (though not always) let colleagues I'm travelling with know to get emergency medical help if I don't wake up in the morning, since I have a history of severe overnight lows that continue even though I've been using a Dexcom at all times for the past three years. I also usually mention where my EpiPen is in my bag and give a brief demonstration of how to use it. Although I bring glucagon on trips, it's intended for mini-dosing only, and I don't expect any colleagues to use it.

All of this may seem like a lot of work ... and it is. But it gets easier each time, to the point that it becomes almost routine. And it's worth it to be able to travel in relative relaxation, minimizing the risk of blood sugar swings, allergic reactions, and other medical issues from rearing their ugly head. Before I started implementing these strategies I had allergic reactions on planes and in restaurants and entire days (or nights) spent in my hotel room sick from diabetes, allergies, or both. That is not a fun way to travel! Fortunately, these preparations pay off in allowing me to enjoy the trip work, learn, relax, or join in on whatever everyone else is doing.

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