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I would recommend wearing water shoes, or something to cover your toes, while you're walking over the rocks in the cave. Though the water is clear, it's quite dark, and sometimes you can't see where you're stepping. It's easy to scrape or stub your toes against underwater rocks.

I didn't have problems with bugs. Don't know if this is common, but our guide suggested that hikers not wear bug spray. You'll be crossing the river at several points on the hike to the mouth of the cave. The guide said that, with so many people visiting the cave, there was lots of bug spray and deet washing down the river. He told us that the local people who rely on the water were getting sick from drinking it.