In 2013 travel blogger Jodi Ettenberg contracted dengue fever. A former lawyer turned writer, by the time she got sick Ettenberg had been a professional traveler for five years with no plan of turning back any time soon. She wanted to get better and get on with her life.
"Dealing with health issues as you travel wasn't something I kept in mind or did anything preemptive about before," she said. "I was more like many travelers. I got sick as I traveled, and that was just something you dealt with, food poisoning or anything else. You had your first aid kit and your packing kit. It wasn't until I got sick that I had to start thinking about it as a preemptive thing."
"It's almost like it changed something in me and the way my immune system processes generally," she added. "A lot of my friends did fine. I'm one of the few that really has seemed to have continuous issues."
And the disease didn't let go.
Thanks to some pre-existing immune system problems, the pain from dengue lingered. Long after the virus cleared that pain remained, settling, in her words, into "my new normal." Nevertheless, Ettenberg is still traveling, and dragging the consequences of dengue along for the ride.
She has no intention of stopping. Instead, Ettenberg has dedicated herself to writing about her journey and what it's taught her about how travelers can cope with chronic disease, food allergies and immune conditions. One thing she's learned?
They absolutely can.
Among of the most common of those challenges is food allergies. A condition which can range from irritating to life threatening, allergies are particularly exacerbated by the unusual food far from home. Where the average sufferer can simply avoid familiar unhealthy meals, overseas it gets a lot trickier.
Will travelers with a shellfish allergy necessarily know that Thai cooking uses shrimp paste and fish sauce (whether or not there's fish in the noodles)? How about those with lentil allergies, will they even think to research the flour that Indian kitchens coat every surface with?
For Ettenberg, it became a particular issue as a food writer with celiac disease.
"Having the inability to digest gluten certainly limits me in certain cases," she said, "for example my travels to Japan, it was so hard because everything has soy sauce and I got sick a lot."
"A chef [there] can train for up to 10 years before they're allowed to touch a piece of sushi," she added. "To see the majesty and the artistry that goes into a piece of food, it was so hard not to be able to partake of it."
That doesn't mean a trip is off the table, though. Travelers should research their destination thoroughly, with a specific eye towards their own needs and limitations. Quirks like the prevalence of gluten in Japanese food may not appear at first thought, but better to find them in advance than after getting sick over a bowl of miso soup.
And take to the streets. As Ettenberg recommended, street food (in addition to showcasing some of the world's best cooking) means meals prepared on the spot. Nothing that lingers all day, and ingredients that are added out in the open… just in case the chef reaches for that bowl of peanuts.
Finally, consider taking translation cards that lay this problem out in nuts, bolts and the local language.
Many countries, particularly in South Asia, often treat food allergies as a Western affectation. Cards, such as those offered by Ettenberg, hop the language and culture gap to explain exactly what's going on, and why a dash of fish sauce would be such a big deal.
Traveling with a chronic illness, such as diabetes or heart disease, adds a whole new level of complication to this issue. Although a personal illness involves fewer people than talking to every chef, it's no less a challenge to solve.
It is, however, a solvable one. As Menash Michael, the founder of Insulog and a diabetes patient for over 30 years, explained, illness doesn't have to stop people from taking their big adventures.
It just forces planning.
"You've got to be prepared for anything," he said. "Life is like that. You never know what's going to happen, but when you are traveling you're more in the places that you never know what to expect."
Take health insurance, for example. Ordinarily something that few vacationers worry about over a ten-day trip, this is something that travelers with a chronic condition should absolutely check on before heading out the door. The same holds for access to local doctors; not a concern for most people, diabetic travelers should absolutely look up where they would go for replacement insulin.
Patients shouldn't risk needing those replacements though. Always keep necessary medicines someplace safe, such as carry-on luggage or the hotel room, and plan ahead for storage concerns. Don't get caught in a room with no refrigerator and pills that need to stay cold.
Perhaps most of all, patients need to simply pay attention to the foreign stress that travel will place on their bodies. Far from home and their routines, including diet and wellness patterns, a vacation can be exactly the right environment to aggravate illness.
Travelers can, and should, stay one step ahead of that.
"We check our blood glucose a couple of times a day," Michael said as an example, "and when you are traveling you check your blood sugar more often, because when there's a different time zone or different food or different atmosphere it influences the body so you have to take care of yourself more often."
An adventure means challenge and hardship, and sometimes real risk. No one knows that better than people who already suffer from chronic pains or disease. For many, the safest answer is to stay at home in an environment that they can control.
It is the safest answer, perhaps, but not always the best.
The world is out there and wanderlust can overcome even hardships such as diabetes or a deadly food allergy. It takes planning, care and attention to detail, but a determined traveler can still get out the door.
"Those are the only two options in life, to act or accept," Ettenberg said. "This is something that is who I am for the moment, for right now, maybe not forever, but it's something that is who I am for the moment. The lessons I've learned in this time these are lessons that I needed to learn as a human. If I was in Montreal or New York I also would be burning the candle at both ends."