I am thrilled to note that during the course of my four and a half month trip around the world, I did not have to start a cycle of prednisone. I did become a bit more symptomatic at certain points throughout the journey, and I almost brought myself to call my GI and get his approval to start on prednisone. Thankfully, these mini-flares (possibly due to my stomach adjusting to new foods, etc) went away just in the knick of time. I certainly did not want the powerful mood-affecting steroid to impact my experience.
I think I did a better job of keeping my Humira cold during the Australia/NZ part of my trip due to a few reasons. First, I discovered a potentially better system of keeping the drugs cold. Instead of using the frozen ice sheets, which I suspect lost their effectiveness over time, I started sandwiching the pens between two bags of ice in my lunch box. During the morning of a travel day, I bought a bag of ice from a convenience store (In Vietnam, you would have to be more creative or just use ice packs because convenience stores don’t sell ice). I would then fill two gallon zip lock bags about half full with ice. One went under the pens and one on top. On long buses, the ice would stay frozen enough for as long as about 12 hours. Even when the ice partially melts, the ice cold water in the zip lock bags surely keeps the pens at proper temperature. I always made sure to wrap my lunchbox in as many grocery bags as possible because the lunchbox would get wet and start dripping over time. This configuration of the Humira pens may not have been possible earlier in the trip because I was carrying around more pens which left less room for bags of ice. In addition, the extreme heat of Asia would have melted my ice much faster. The fact that it was winter time in the southern hemisphere took some pressure off keeping my pens chilled. My main point is that no matter where you are in the world, there is almost certainly a means of keeping your Humira pens cold. Just be prepared with some sort of freezable ice pack or sheets and plenty of zip lock bags.
I spent a great deal of time before my trip worrying about how I was going to get my pills, pens, syringes, and liquid medicine through security, customs, and long plane rides. I got letters from my doctors and did lots of research about each country’s policy on bringing in prescription drugs. I am beyond pleased (and slightly disconcerted) that airport security never gave me a hard time about my medication or its accessories. No one ever even questioned my zip lock bag full of syringes. I occasionally received a question about the Humira lunchbox. Upon telling them it contains a medication that needs to be cold (“It’s like insulin”), security never took a second look. Customs was the same way. Asian customs is very lenient on this topic as they do not even ask you to declare your drugs. I remember declaring the medication upon entering New Zealand, but the officials did not care to look inside my lunchbox. Many of the airlines were more than happy to keep my lunchbox in a cooler throughout the flight. Some refused for ignorant company policy reasons, but they were willing to keep refilling my lunchbox with ice.
Traveling with Humira may seem somewhat daunting at first thought. And the truth is, keeping the pens cold becomes a significant part of your trip. But just because it’s significant does not mean it’s stressful. As soon I got to a new city, I always kept an eye out for where I could either freeze my ice sheets or acquire ice for the next travel day. I woke up a bit earlier than normal on travel days so I could go buy ice if I wasn’t using the ice sheets. Much like the disease itself, you can’t ignore Humira but you don’t have to make a big deal out of it. Please don’t be discouraged to travel if you have inflammatory bowel disease, especially if you take Humira. I didn’t let it stop me from traveling. I survived to tell the tale, and I know you will too.