Travelling with Lymphoedema: South East Asia

Note: S.E.A = South East Asia

In my last post I described my experience of travelling across Indonesia with lymphoedema. The plan was to do this for every country I visited, but, when I finished writing the Malaysia edition, I realised it was all a bit “samey”. That’s not to say the day-to-day experiences of each country were the same, but rather how my lymphoedema responded to the environment was similar.

That’s why I’ve decided to write one mothership post, detailing what one can expect if they were to embark on an adventure across South East Asia. I will then do the same for East Asia which currently has a very different climate (it’s snowy here, minus ten and I am freezing my a*se off).

So, South East Asia. Big place, absolutely manic and certainly not the most welcoming of environments for lymphoedema, especially for those with the intention of backpacking. Take one minute to study the dangers of travelling here (with lymphoedema) and you might think it was a no-go, risk-ridden mass of land almost certain to hand you a healthy dose of cellulitis. On paper it is, but, with a bit of caution and some common sense it can be scaled, explored and enjoyed like any other part of the world… Well, nearly.

I spent roughly two and a half months in South East Asia, starting in Indonesia and passing through Malaysia, Singapore, and Thailand, with Vietnam concluding our stay.

It’s a fantastic part of the world which bursts with tradition, colour, history, flavour and the friendliest people you will likely ever come across. There is a stark difference between every nation, especially when you consider the modern capitalist powerhouse that is Singapore compared to say, communist Vietnam. However, every single one of these countries shares typically Asian characteristics, some of which lend themselves kindly to travelling with lymphoedema, some of which do not.

I’ll break these down for you and offer some tips whilst I’m at it:

Weather

In most of South East Asia they have a variety of seasons. In fact, the seasons differ from region to region within the same country! In the rainy season you will experience reoccurring biblical downpour which will leave you soaked head to toe. Miniature streams will form all around you and all but the brave (the locals selling ponchos) flee inwards. The good thing is the rain reduces the temperature slightly giving you a temporary break from the scorching heat.

However, I found at times my lymphoedema (left leg) was not too appreciative of the wet. My feet got drenched meaning I was regularly drying myself off and applying aloe gel between my toes – a real problem area for me. Litter and waste also moved with the wet, allowing polluted puddles to punctuate the streets. Not an issue if you’re careful, big issue if you misstep. Either side of the rain however came plenty of glorious sunshine.

Temperatures hit the thirties in Malaysia. The lowest temperature we experienced was around 18 degrees in Vietnam. If you could see both Charlotte and I before we left, you’d have thought us ill. Pale we were and prone to burning too, but after enough time soaking up the rich vitamin D we began to tan. But, as wonderful as the heat was, it didn’t take long before it had its way with my leg. I swelled like a balloon at times. The sticky heat wasn’t too comfortable either making my stocking a chore to get on and off, with chafing a frequent problem.

Bring a cooling spray with you such as the menthol infused one Medi supply. Rub it on your problem area and your stockings too. It’s not going to cool you down entirely but it helps nonetheless. Make sure you perform massage twice every day when you can, it goes a long way into relieving a heavy limb after a long day in the heat.

Relevant to: All countries.

Hygiene

In many parts of S.E.A sanitation is lacking somewhat. Some call it unhygienic, some call it relaxed. In tourist or popular spots you tend to be fine. In lesser known, more rural areas you might (definitely) need to bring hand sanitiser and toilet roll. It’s all a part of the backpacking experience I guess, but, bear in mind with lymphoedema there needs to be a certain amount of consideration. I.e. are you particularly prone to illness – especially cellulitis? Expect sneezing with no cover, spitting from the locals (especially elderly folk), stray dogs and cats (in restaurants and homestays).

Relevant to: all countries apart from Singapore.

Religion

The religions of S.E.A are an integral part of its cultural makeup. With Islam, Hinduism, Buddhism and Christianity making up the major sects, you won’t go a day without stumbling across a beautiful place of worship.

Buddhist temples of shimmering gold; stunning geometric patterns which characterise traditional Muslim mosques; Hindu temples decorated with more colour than a rainbow – it will leave you speechless. With these holy grounds come one common trait – the removal of your shoes. After a while it does become frustrating, but if you want to see inside these stunning religious buildings it’s the price you need to pay. Keep an eye on the floor as although some places claim to enforce it, they definitely don’t. If the floor looks mucky consider giving it a miss. I brought spare socks with me that I could put on when necessary.

Relevant to: all countries.

Environment

Okay, it makes sense to start with hostels and homestays as they form your basecamp. Most have a shoes off policy which, although understandable, is annoying as unlike areas of worship, hostels and homestays tend to be dirty, well comparatively (especially in the bathroom). It’s not hard to find somewhere cheap and clean however, just do your research and always read the reviews as pictures are often misleading!

A typical trait of S.E.A culture is the famous squatting toilet. Although supposedly the correct position for adhering nature’s call, it does put a strain on your legs. It is definitely not the place you want to slip over in either.

Holes the size of wells line the streets in most of S.E.A sparing only Singapore. Health and safety isn’t too strict in these parts and it is not uncommon for broken windows, fences and railing to be left as they are, exposed to those passing by.

I adore beaches. Especially tropical ones with white sand and sparkling turquoise water. I had yet to experience sand with my lymphoedema as all previous holidays since my diagnosis had been city breaks. The sand gets EVERYWHERE. Your stocking will retain the grains for days to come and can make things a little sore. Bring plasters and aloe gel in your bag, and maybe a spare stocking just in case.

Insects really weren’t too much of a problem for me, even when I did get bitten I was tentative and always kept a close eye on my bites. I sprayed myself with the bug repellent, Deet, daily. Be warned however, it is very strong so if you have particularly sensitive skin try a herbal equivalent which will usually contain lemon and eucalyptus. I kept my legs covered with soft baggy traveller pants which also kept my legs cool.

Relevant to: all countries.

Commuting

Alongside the heat, commuting has caused me a lot of pain throughout my travels. I would advise to always spend extra to get the best seats, but be aware the etiquette is different. Just because your coach ticket says “seat 1B” means nothing. If you ask politely people tend to move over, but this is no guarantee.

All lymphies know the complications with flying. Wear your stocking, keep moving around, book your seats in advance and ask for assistance at the airport.

Trains have perhaps been the biggest cause of grief for me. In the UK, disability awareness tends to be quite good but only when your condition is overtly present. It is not too dissimilar in S.E.A. The people are extraordinarily kind and will make way for those in need e.g. a pregnant or elderly person. However, I received a lot of stares for taking seats when my leg was in pain and I had no way of communicating my condition. You’ll be up and down like a yoyo, walking stop to stop, platform to platform. It does take its toll eventually. Don’t be a hero, take regular pit stops when your body has had enough.

Download the app Grab (Asian equivalent of Uber). It’s a cheap and easy way to commute around. If you are able, hire a bicycle – it’s even cheaper, good for pumping your leg and a great way to see the sights!

Relevant to: all countries, especially the cities of Bangkok and Kuala Lumpur.

Diet

You’ll need some time to adapt to the food which IS delicious but considerably spicy. I tried my best to taste as much as I could, but some things just didn’t agree with my palate. Two words: chicken feet.

Excuse me in advance for not softening the delivery of this next sentence. You will likely spend a lot of time on the toilet while you adjust to the S.E.A cuisine. It’s really important that you stay hydrated during this integration period as you will lose hella’ bodily fluids which does no favours for lymphoedema.

We have ADORED the food in every country. The difference in taste between each region is distinct, delicious and delightfully satisfying. In Indonesia it was not hard to stay healthy due to the vast amount of cheap fruit. I drank a coconut daily as a minimum. The rest of S.E.A has a real, and I mean really real, taste for chicken, pork and of course, rice. In fact, at times it was hard to get our hands on veg and we had to head to more westernised “health bars” to get our nutrition up. Most of your diet will consist of meat and carbs which aren’t the best options for keeping your lymphoedema in check.

Try to load up on fruit and veg in markets, but be careful not take anything pre-chopped as you won’t know how clean the utensils are.

Finishing note

South East Asia is wonderful place. Friendly, beautiful people, amazing food, stunning sights and never a dull moment.

When travelling this region with lymphoedema you just need to be aware of a few things and bring the appropriate gear to combat any issues (see a condensed, more concise list of travelling tips here). I brought a spare sum on of money which could only be touched in case of emergency and that pot soon ran out. Emergency flights, expensive coaches and above average accommodation for bad leg days – you’ll be surprised at how often you need to a rearrange.

Know your limits, know your body and come ready with a day-to-day plan. You will experience down days forcing you to cancel, rethink and rest, but in doing so you will have the energy to keep on going!

If you have any questions that I might have missed please fire away in the comments section!

You can keep up to date with my travels on Instagram @leftlegfirst_travel

My Lymphoedema Appointment in Singapore

In this blog I describe my experience of treatment in Singapore. I also share some tips I learned along the way. If you wish to skip to the tips, jump about half-way down the page to the section titled “Tips from Veronica”.

Amidst the chaos of Mt. Agung’s “imminent” eruption (it still hasn’t erupted), our flight to Singapore was cancelled. As tourists relaxed on the sandy beaches of Indonesia’s glorious coastlines, the volcano exhaled a giant puff of ash and with its molten breath the airlines stopped all flights in and out of Bali. Luckily for us, my gut instinct kicked in (superhero Josh to the rescue) the day before meaning we got away just in time. Instead we headed straight to Malaysia, although a couple of weeks later we would find ourselves in Singapore anyway having the most wonderful time.

At a later date I will share my day-to-day experiences of the various countries I’ve visited over the course of my travels however, for this post in particular, I would like to focus on the treatment I received for my leg in Singapore.

The Masso Institute, Singapore.

Before we left the UK I posted about my upcoming travels on a lymphoedema support group. Someone kindly dropped me a tip about the Masso Institute in Singapore and said to check them out should I need treatment. It’s just about the only place in South East Asia to receive lymphoedema care, so, if you’re ever in that part of the world make sure to keep them in ­mind.

The clinic, run by a lady called Veronica, is quite small and unsuspecting, sitting in a sort of student shopping mall (when you see it you’ll know what I mean). It’s clean and cool, and the relief of knowing you’re in good hands (note the non-intended pun) settles across your body the moment you walk in.

Reassuringly I was asked to fill in a medical form and soon after I made my way into a treatment room where an assistant measured my legs. The results weren’t great as Veronica made very clear and with a teacher-esque authority, she began to interrogate me as to why I had allowed my leg to become so fibrotic. Before the appointment I thought I was doing quite well, but, after an hour or so with Veronica, let’s just say the standards of self-care I had set myself increased somewhat.

I had been meandering around Singapore with a solid, heavy leg during the days leading to my appointment. In all fairness I had been hiking in Malaysia so I think I was still recovering from that! Needless to say the leg wasn’t too comfortable, and when I showed Veronica my stockings and demonstrated my usual exercises she responded with this…

“That won’t do a thing, you might as well have nothing”.

You see, my then compression garment was not up to the job. It was old, unfitted and not strong enough. My leg was far more swollen than before I left the UK (due to various factors) and so wearing my usual garment was fruitless. Same with the exercises. The pressure I was applying was too light, it needed more force. Luckily for me Veronica had a new, much tighter garment lying around in my size, as well as a few tips for the road.

She put me in the pump which was just what I needed. I had never been in one that wrapped around my torso as well as my legs before. It squeezed me so tight I felt light headed!

The appointment was fantastic. I learned so much about treating lymphoedema in my short time at Masso. Veronica is extremely knowledgeable on the subject and a skilled therapist too. Let me take you through some of the bits I learned along the way…

Tips from Veronica

Swimming pools: Now then, most of us know that a dip in the water is great for treating lymphoedema. Swimming is wonderful, but actually hydro-walking is the best exercise for us lymphies. The pressure of the water in the depths of the pool stimulates our lymph flow, forcing the lymph up from your feet. Not only that, the pool is nice and cold making it an ideal counter to intense, hot weather.

Tip: When backpacking try and find a hostel close to the sea. If you can’t, find an apartment block or hostel with a pool. I would tend to pick an apartment over a hostel for hygiene reasons. We found this place for £30 a night:

Ice-packs: Now, in the extremes ice isn’t great for us lymphies. But, in small doses, ice can provide a really easy way for quick relief. Some of the more popular backpacking destinations involve braving hot climates which can make things unbearable for those with lymphoedema. If you purchase yourself an ice-pack, you can put in your hostel/apartment freezer and cool your leg down in moments of need. Wrap the pack in a tea-towel and stroke up your leg gently. Don’t put the pack straight on your limb or it will be too cold for your lymphoedema.

Tip: Don’t worry, if you forget an ice-pack, just buy an ice-tray and empty the ice into a plastic bag and tie it up.

Get a shift on: Contrary to the former consensus amongst lymphoedema therapists, to shift lymph, in particular fibrosis, one needs to be firm when performing self-massage. Stroking a fibrotic limb will not do anything as I found out. Use the edge of your hand, and pull down your limb (towards your groin or pit) with enough force to really feel it (not too hard though!).

Tip: Purchase a massage tool like the one pictured below. I picked mine up for 20p in a Thai market. It makes things a little easier and is small enough to fit in your rucksack.

Essential oils: If, like me, you are an advocate of herbal remedies then this one is for you. Using a combination of essential oils, including frankincense and myrrh (shout out to the wise men), Veronica has created a formula that prevents cellulitis. In fact, after testing it for nine years, not one of her patients had a bout of cellulitis.

It wouldn’t be fair for me to list the ingredients, so if you wish to get your hands on her formula, please get in contact with her directly through the Masso Institute website.

It was a real pleasure to meet Veronica. If ever I should be back in that part of the world, I would gladly pay the Masso Institute another visit, not only for treatment, but to see a new friend too.

Visit the Masso Institute at www.massoinstitute.com

Been to any other lymphoedema clinics in Asia? Let me know!