What prescriptions or medications are available in Costa Rica? I’m still working on getting all the info, but here’s what I’ve got so far.

In Costa Rica, there are two avenues for medical care (hospitals, clinics, and pharmacies): private and public. Any medication you can get at a private pharmacy you can get at a public pharmacy (at a public hospital), but not vice-versa. Some medications are more closely controlled by the “caja” (public system).

Prednisone - Easy to get in just about any pharmacy. No prescription needed.

6 mp (purinethol) - This is harder to get. You need a prescription from a doctor in Costa Rica, then you must go to the ‘caja’ for approval, then you can go to a public pharmacy in San Jose. It’s only about $3.50 for a supply of 100 pills. Private hospitals can get it if you’re admitted.

Asacol - You can get this in most private pharmacies. I’ve only seen 500mg pills. No prescription needed. Try asking for Pentasa. It’s about $70 for a box of 500 mg tablets (I think 50 tablets, but it could be 150–my writing was a little sloppy)

Entocort - Not available in Costa Rica. There is another form of the active ingredient (budesonide) called rhinocort, but that is for nasal allergies and won’t work for IBD.

Remicade - I spoke to a leading gastroenterologist in CR who said this is regulated through the public system. Based on other conversations, I would venture to guess that a private hospital could access it through the public system if you were admitted.

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Join me for an adventure!  IBD accommodated

Joe Richards

Owner - Mango Travel

www.mangotravel.us

joe@mangotravel.us

I have to admit, planning ahead is not one of my strengths; I tend to plan the trip about a month in advance and pack the night before. That’s not ideal for IBD, to say the least. For me to see my doctor, the appointment is usually 3 or 4 months out. Luckily he has assistants and coordinators who can get things done pretty effectively.

If you know you’ll be traveling at some point in your life, you can have some of these conversations with your doctor during any visit. Be sure to ask your doctor:

• about taking anti-motility medication before you leave home.
• about treating traveler’s diarrhea should you develop it while traveling
• for written, back-up copies of all prescriptions
• about a written statement summarizing your medical history and medications
• for a list of physicians in the cities you plan to visit
• for a written plan of action for you, in case your condition worsens
• to ask if the climate at your destination will affect your medications (such as lots of sun)

Your doctor’s assistants probably won’t appreciate a call on Wednesday saying you’re leaving on Saturday and you need all these things. Be sure to give them at least a couple weeks notice so you don’t find yourself up a creek without a paddle abroad.

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Join me for an adventure!  IBD accommodated

Joe Richards

Owner - Mango Travel

www.mangotravel.us

joe@mangotravel.us

The wretched pre-existing clause. The good news is there is affordable travel insurance out there that covers pre-existing conditions, and at no additional charge! I have partnered with Travel Guard to sell their insurance products, many of which have pre-existing clause waivers, under reasonable conditions.

Again, this issue can be accommodated by planning ahead. On certain policies, Travel Guard will waive the pre-existing condition clause if:

(summary)

• You purchase the policy within 15 days of making the initial trip payment
• The amount of trip cancellation coverage purchased at that time equals the full cost of all pre-paid non-refundable trip arrangement.
• You must be medically able to travel when premium is paid
• Applies to the first $15,000 - $50,000 of trip cost per person, depending on the policy.

If you would like to purchase a policy that covers pre-existing conditions, please click on the the following image, or call me (Joe) @ 612-205-6417

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Join me for an adventure!  IBD accommodated

Joe Richards

Owner - Mango Travel

www.mangotravel.us

joe@mangotravel.us

Picture this. I’m sitting in my window seat, next to two strangers, in the middle of the coach section. During my layover, I gave in to my travel food urges and got the quarter pounder with cheese value meal at McDonald’s. By the way, my gut, and entire body (apart from taste buds) for that matter, hates fast food. It tends to make me ‘go’ repeatedly.

Great.

Long story short, the plane ride was one of anxiety, discomfort, and pissing off the flight attendants for being in the bathroom when the seatbelt light was on.

Since then, I’ve taken some very simple measures to be sure I don’t let that situation happen again.

Here are some tips for having a comfortable plane ride.

Choose your seat

I think every traveler out there has had issues with bathroom access being blocked by food service. Get a seat next to the bathroom. Do you ‘gotta go’ repeatedly? Get an aisle seat if you want to minimize interruptions of other people. Be sure to choose your seat before you show up to the airport (either online or by calling the airline), otherwise your options may be limited.

Communicate your concerns to the flight attendants before the flight.

If you explain to the flight attendant that you medical condition causes you to have unpredictable bathroom patterns, they may:

• Invite you to use the first class bathroom if the coach one is occupied
• Allow you to use the bathroom during fasten-seat belt times
• Allow you to get up and walk around if necessary

Enter the plane last

Yes, they invite people with ’special needs’ to go on the plane first. Well, many of us with IBD don’t like to think we have ’special needs’, and it just doesn’t make sense! Sit there on the plane, trapped in your seat, aisle blocked, and we’re still not invited by the pilot to use the bathroom until like 10 or 15 minutes into the flight??? No way, put me on last.

Get a cushy layover

Do you have the choice between the 45 minute connection or a 2 hour connection? Consider the time it will take to go through customs (returning to the US); if you’re rushed to get to the connection you may not be able to find time for a bathroom break. Plus, it will make you more stressed out!

Pack your meds on your carry-on

The airline wouldn’t ever misplace your bags, would they? Yes. The answer is a big yes. Keep ‘em with you.

Pack a “bathroom kit” and carry it with you.

Accidents happen to some of us. It would be awful if it happened on a plane; it would be horrendous if we weren’t prepared. Include at a minimum extra underwear, shorts/pants, and a plastic bag. If you’ve had even a small accident in the last few years, you should do this.

Take your meds

The cat’s already out of the bag that IBD patients are awful at taking their meds. Guess what, they help. Get back on them and stay on them even if you’re feeling fine. It’s called maintenance for a reason. (trust me, I’m looking in the mirror right now). Remember, it can take weeks before certain treatments can be effective. This will help you be healthy on your flight.

Eat well

Whatever your sinful craving is that upsets your stomach…control yourself! I know, it can be easy to change our eating patterns when we’re at the airport and our options are limited, but we must take care of ourselves! Do whatever it takes: pack a tasty lunch (if it can get through security) or start thinking about times you felt awful with IBD then think about the foods that are the culprit.

First be honest with yourself about the problem. For me, I don’t generally like fast food, but when I travel and am at the airport, I transform back into my 16 year-old self who loves McDonald’s. Ok, that’s the problem. Now to deal with it. Honestly, I don’ t like their hamburgers that much, mainly just their fries. So my plan could be to get a sandwich at Subway, indulge in an order of fries, and then indulge in a Snicker’s bar. Not the healthiest meal, but it won’t upset my stomach.

It may seem like a lot, but once we understand the reason for each tip and start putting them into practice, it will just become habit.

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Join me for an adventure!  IBD accommodated

Joe Richards

Owner - Mango Travel

www.mangotravel.us

joe@mangotravel.us

I have been to Costa Rica many times, and I trust that the water there is fine. In fact, I have almost always drank the tap water, but recently I’ve decided to mainly drink bottled water, especially when I’m leading a group. Our bodies are dealing with a lot of change (read: stress) when we travel abroad; they must adjust to many new conditions. Local water can still bother your system even though it is not contaminated, within a couple weeks of arriving we may become sick. If you are taking a short trip, it is best to drink mainly bottled water. I’ll still occassionaly drink tap water, and I don’t worry about the ice. I just think in terms of reducing stress on my body. A little fever isn’t a big deal, unless your on vacation!

Communicate your concerns to the flight attendants before the flight. They may:

• Change your seat to be near a bathroom
• Invite you to use the first class bathroom if the coach one is occupied
• Allow you to use the bathroom during fasten-seat belt times
• Allow you to get up and walk around if necessary

Be extra cautious with food and water. Consider:

• Sticking to bottled water.
• Avoiding non-carbonated beverages such as ice tea and fresh juices.
• Avoiding raw vegetables or salads
• Never eating prepared food, such as potato salad and canapé
• Note: Local food is an important part of an international experience. Consider your own health condition, recommendations from guide books, and, your ‘gut feeling’.

Eat and drink healthy food

• Be cautious of drinking more alcohol than usual.
• Be aware of your ‘new diet’ while abroad compared to what you normally eat at home. Are you eating more roughage, processed foods, meats, etc?

Drink plenty of water

Becoming dehydrated stresses the body. When travelling to a new destination and new climate, it’s easy to forget to drink water as we are out of our normal routine

Danger Signals. Contact a physician immediately if you experience any of these symptoms:

• High fever, and shaking chills;
• Profuse bloody diarrhea;
• Severe abdominal pain and/or abdominal distension, especially with abdominal tenderness or nausea and vomiting;
• Fainting or dizziness when standing up;
• Marked decrease in urine.

Be extra aware of where bathrooms are.

Although you’re probably used to this at home, there may be much fewer bathrooms and you may have to deal with language barriers

It may seem like a lot, but any international trip requires extra planning, and most people need to do much of this for one ailment or another anyway. International travel is a true joy and provides so many lifetime memories.

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Join me for an adventure!  IBD accommodated

Joe Richards

Owner - Mango Travel

www.mangotravel.us

joe@mangotravel.us

We all know that IBD is a very personal, and each person’s experience is unique. Only you can say whether you feel comfortable traveling, but I hope this blog can help people with that decision and even enable them to travel more internationally.

In the 10 years that I’ve lived with the joys of Crohn’s disease, I have traveled internationally enough to rightfully have a personal email that is whereisjoe@gmail.com! Crohn’s has not stopped me from the following:

• 3 months in Belize (at age 19 within a year of being diagnosed)
• Study abroad in Costa Rica (1 semester)
• Various short and long trips to Costa Rica, sometimes leading groups
• 6 weeks in Italy
• Short trips to Mexico, Panama, and Nicaragua

My Crohn’s hasn’t been exactly dormant either. I’ve always had flare-us 1-3x per year and have even had one in Italy and in Costa Rica. There is a lot I have learned in these experiences, some through doing it right, others from doing it wrong (8 hours bus ride with 1 stop and no on-board bathroom made me nervous). The most important thing I can say is that we should do everything we can to not let IBD impede us.

It is my belief that we are extra prone to becoming sick abroad because of a combination of subtle stresses we put on our body that can add up and may include:

• Sleep deprivation
• Change of climate
• Time changes
• Dehydration
• “shocking” our system with different water and foods that it’s not accustomed to (not that they’re necessarily contaminated)
• Drinking more alcohol than usual (margarita anyone?)
• Stress of trip planning / interpersonal conflict
• Stress of being out of one’s comfort zone / experiencing culture shock
• Stress of worrying about getting sick (at some point you just have to have fun)

Enjoy the articles, write your own advice, ask questions, write stories (funny, serious, or whatever!).

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Join me for an adventure!  IBD accommodated

Joe Richards

Owner - Mango Travel

www.mangotravel.us

joe@mangotravel.us

The first time I arrived in Costa Rica when I was 21 years old and studying abroad, I figured I’d just take the bus to my specific destination. No, I did not make that decision with Crohn’s disease in mind, like I should have. I was fine, but that caused so much anxiety when I realized we’d just be making one bathroom stop. Being the only foreigner on the bus and not being the best Spanish speaker, that made me feel very uncomfortable. If everyone on the bathroom doesn’t need a special stop, why should they make a stop for the foreigner? That’s what I was thinking, at least. What really got me worried though it, what if they stopped, and 10 minutes later I had to go again? And again in another 10 minutes? Not to mention the fact that most of these bathrooms don’t have toilet paper in them.

The point is, being affected by IBD, we need to plan ahead a little bit. Here are some predeparture planning tips for international travel. It’s an exhaustive list; take what works for you.

Research your destination

• Buy a Lonely Planet travel guide
• Have a simple understanding of the medical system.
  • Example: In Costa Rica, the pharmacy is generally is generally the first stop when people are sick. The pharmacists are trained to treat minor ailments and provide medications without prescriptions. Every town has one or two.

The bathroom situation

• Are there many (or any) public bathrooms? Do you typically need your own toilet paper?
• Know how to ask where a bathroom is in the host county’s language.

Low-stress itinerary

• Get flights with good connections and departure times
• Consider a tour or package deal from a reputable company
• Reconsider renting a car – this can lead to many stressful situations
• Give yourself time to decompress at home before going back to work

Contact your health insurance provider

• What are coverage rules abroad?
• Will they reimburse?
• What are their limitations?

Buy travel insurance. It should cover:

• Emergency evacuation (i.e. send you home on MedVac)
• Emergency reunion (i.e. pay for you to have a visitor if hospitalized)
• Medical expenses (just in case your HMO gives you surprises)
• Pre existing conditions

Check your medication and doctor visit schedules when picking a date

• Be sure to not only have enough pills for your trip, but also for when you return.
• Try to travel between scheduled appointments

Contact your doctor

• about taking anti-motility medication before you leave home.
• about treating traveler’s diarrhea should you develop it while traveling
• For written, back-up copies of all prescriptions
• about a written statement summarizing your medical history and medications
• for a list of physicians in the cities you plan to visit
• for a written plan of action for you, in case your condition worsens
• to ask if the climate at your destination will affect your medications (such as lots of sun)

Visit a travel clinic

• For valuable information on staying healthy in the host country
• For necessary medications and shots

Bring

• Needed documents and medications with you
• Your doctor’s phone number and your health insurance card in your wallet.
• Medications in their original pharmacy bottles.
• Enough medications for a few extra days in case of surprises.
• Pack a “bathroom kit” and carry it with you.
  • Include extra underwear, tissues, antibacterial hand wash, plastic bags and anything else you may need if you encounter a lavatory that is not clean or properly stocked.
• Be sure to be ‘extra healthy’ the weeks leading up to your trip, if possible. Get exercise, sleep and eat well, take your meds.
  • Allow plenty of time to pack for trip so you’re not stressed before you’ve even left!
  • Get plenty of sleep the night before departure

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Join me for an adventure!  IBD accommodated

Joe Richards

Owner - Mango Travel

www.mangotravel.us

joe@mangotravel.us

Would you believe me if I told you my quickest, cheapest, and most comfortable clinic/hospital visit from a flare up was in a small rural town in Costa Rica? While Costa Rica may not have the newest, most expensive technology, they do have quality, trained doctors. In fact, doctors who work in private clinics and hospitals are required by law to work in public hospitals, so to not have a division in care quality.

Here are some reasons why I Costa Rica can serve well an IBD traveler in need:

1. Gastritis. Costa Rica is has a high rate of what they call “gastritis”, inflammation of the intestine. Doctors, nurses, pharmacists, and regular people are very familiar with gastrointestinal inflammation
2. Excellent health. care Doctor who work for private clinics are required to also work in public facilities to ensure there isn’t a gap in care quality.
3. Health care is cheap. Emergency care is free at hospitals, and if you do have to pay for anything ever, it’s a few hundred dollars or less.
4. Medications widely available. Every town has a pharmacy, and they’re one of the few places open late!
5. Hassle free medications. Pharmacists have the authority and training to sell medications without a prescription.

My story I was hospitalized once with a flare-up in Costa Rica and it was my best treatment experience ever. Fast, cheap, and good. I was in a small, isolated rural beach town and had a flare-up. I had two choices: go to a private clinic in a one-horse town a half hour away, or go about 4 hours to the closest hospital (not far in distance, but required waiting for a ferry to take us across the peninsula). I was skeptical of the private clinic, imagining high costs and inadequate care. I was wrong.

I arrived to the clinic where a nurse doubling welcomed us and called the doctor to come in (he comes in when there are patients). Five minutes later, I was in an air conditioned room with a well-trained doctor and nurse there to treat me, and only me. They quickly got me hooked up to an IV and got some pain medication in me. The doctor, who spoke English, asked me what my symptoms were and what treatment is usually effective.

It wasn’t that he didn’t know what he was doing. In Costa Rica, and in many other countries, doctors understand that people know their bodies and how their bodies respond to certain treatments. I know when I’m having a flare-up. I’ve had about 2 a year for the last 10 years. Every time I go to the hospital they do about $10,000 worth of tests, but ultimately only give me prednisone, pain medication, and IV fluids.

I quickly felt better, and an hour later I paid about $100 for the service and medications. No HMO or surprise bills. The pharmacy was right next door and I immediately got my prescriptions. Another bonus–If I needed to be seen again regarding the same problem, the private clinic would see me free of charge at any of its locations throughout Costa Rica.

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Join me for an adventure!  IBD accommodated

Joe Richards

Owner - Mango Travel

www.mangotravel.us

joe@mangotravel.us