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Q. I will be travelling to Tanzania in February 2004 with the intention of climbing Mount Kilimanjaro which is 19,000 feet high. Altitude sickness is a major cause of failure when making the attempt. I have been told that there is a medication which can be taken (acetazolamide? Diamox?) to help prevent this.

A. You are correct there. Diamox can be taken 3 times a day and is useful for warding off altitude sickness for those with little time to acclimatise. It must be taken for the duration of exposure to height and simply stop it when you get back to a reasonable level. However it is better to acclimatise normally, and to help reduce this annoying illness, keep off alcohol, ciggies and heavy meals.

Q. I'm currently planning a working/traveling holiday in Australia for 6 to 12 months. I have epilepsy which is controlled by taking medication (300 mg of Sodium Valproate) twice a day. I will take enough to last me two months, but what then? Do I get medication sent over from UK or can i get Epilim in Australia, and would I have to pay for it?

A. Epilim is a real bog standard anti-epileptic medication which is available the world over. There should be no problem in getting a prescription from an Aussie doc whilst you are there. Their medical system is a bit more user friendly than ours and all you have to do is walk into any surgery and explain your need. You will have to pay, and I doubt any insurance will cover it as it is an existing problem. But I doubt it will cost you more than £50 for everything.

It is worth making sure you do not run out in a remote area, so plan ahead, and if necessary take 6 months worth as most meds like this have a 2 to 3 year shelf life.

One final thing. Forget SCUBA diving. As an epileptic you have to be fit free and off all meds for 5 years before you are allowed to sample the delights of the Barrier Reef.

Q. I normally use Sturgeron travel sickness tablets. But would you be able to tell me what (in your opinion) is the best medication for travel sickness.

I was also recommended ginger root tablets - but they recommend that you have something to eat before you take them. When you are feeling ill, the last thing you want to do is eat. Your help is greatly appreciated.

A. The trick is to take the ginger root and food before you get travel sick.

In a nutshell, travel sickness occurs when messages to the brain about position of the head and body conflict with what is actually happening.

Try reading in the car, your brain thinks you are still, but your body is moving and cornering. So the fluid in the semi-circular canals sloshes around the inner ear throwing these messages to the brain, and you feel sick.

An effective med then stabilises the fluid, blocks these messages and stops you feeling nauseus.

Stugeron or cinnarizine is a simple over the counter tablet. It can make you feel sleepy though.

The best ones are always prescription only. Prochlorperazine is good and my preference as it is not sedating.

There are too many more to mention but look at maxolon, domperidone or from the anti-histamine family Serc.

Q. I have a nut allergy and will be travelling to India (Goa) in a couple of weeks. As I am worried about having an anaphylactic shock, I would like to get an adrenaline pen to take with me. I am not currently registered with a GP, so I was wondering whether there is anywhere else I can get the pen from?

A. If your allergy is such that you are in danger of a severe allergic reaction if you eat them then it is a good idea to take one of these pens.

To get hold of one you need a prescription written by a doctor. If you cannot get registered with an NHS GP then you could go privately in your area. This may cost £60 just for the consult with the price of the pen on top of this.

Alternatively you can just go into any GP as a temporary patient, wait, a long time, and plead your case.

When you get the pen, check to see what temperature it needs to be stored at so you can plan in advance if refrigeration is needed.

It is also worth learning the local phrase for “does this food contain nuts” as there may be some hidden extras on any menu.

 

Q. I am going trekking in the Andes over Christmas, but had a problem with altitude sickness the last time I went. I am told that there is a drug you can take to stop it from happening. What is this drug and do you think it's a good idea to take it?

A. The drug you mention is called Diamox, or acetazolamide by its generic name.

It is usually used in people who suffer from glaucoma, where the pressure in the eye increases, or in situations where the lungs become waterlogged with fluid, known as oedema. Its action helps reduce the fluid build up and so the lungs can breath normally.

This is why it has been used in acute mountain sickness or AMS as we also call it. In this condition, because the level of oxygen is much lower the higher we go, our bodies respond by initially breathing faster and deeper, but then the red cell numbers also increase to try to carry more oxygen to the tissues. Diamox helps by increasing our rate of respiration, the effectivity of the oxygenation of the tissues and by preventing the fluid from accumulating in our lungs.

Now AMS is a problem that only really occurs above 2000 metres, and about 50% of trekkers will get it above 3500 metres. However 1 in 20 trekkers will get severe life threatening AMS above this level so you have to be careful and aware of what symptoms you may get.

Now there is no real correlation between age and fitness and AMS. The key thing is that some people are prone to it, with a 60% chance of repeat symptoms at altitude the next time, but the main thing is acclimatisation.

The more rapidly you ascend, the more likely you are to get it.

My advice is to get some Diamox for your trip but only use them in certain situations. This would be after you have attempted to acclimatise properly. This involves spending at least 3 days at the height you have arrived at. You need a high carbohydrate, low red meat diet. Avoid cigarettes and alcohol and remember not to over exert yourself. If, despite all this you still get symptoms of AMS, ie headache, nausea, vomiting and loss of appetite, then you should try to descend to stay at a lower level than you were at before. If this is impossible then the Diamox can be used to treat the mild symptoms of AMS, but you should not go any higher until you have reacclimatized and feel well. If your trek is not going any higher than 3500m then you could stay on this medication, but it has no effects on severe life threatening AMS which could occur above this level and so I cannot advocate its use at these heights as you should not be dependent on medication but be fully acclimatised at these heights even if it does take a week or more to do so.

Finally, never increase your sleeping height by more than 300m a day above 3500m, and if you do start to get symptoms of severe AMS, like persistent cough or frothy pink sputum, then get on oxygen and descend as soon as you can to seek medical attention.

Q. I have just come back from South East Asia where the most terrible thing happened. I am a diabetic and need insulin to control my sugar levels in my blood. After using the needle on the plane to Singapore I was arrested when we landed and hurled into the airport jail. They took away my medication and then left me there for several hours, and if it wasn't for the intervention of the British Consul I would now not be here to tell you this. What should I do next time I go away?

A. This is quite a shocking story and one which you are probably trying to forget now, but I have come across many tales from insulin dependent diabetics who travel extensively in the developing world.

In these countries, yes, needles and syringes are immediately associated with heroin use and as diabetes is a less common condition over in these countries then it is going to take many years for knowledge of this condition to filter through. But what surprises me is that the cabin crew and pilot on this flight were so ill informed that they automatically assumed you were a drug abuser and didn't think to ask you what you were doing.

So whilst these attitudes and ignorance exists then I'm afraid it is up to the diabetic to make absolutely sure that they can do everything to avoid this happening and this involves being forewarned of where problems may exist. I have crossed many borders where there are still very draconian signs warning travellers that if they "have long hair, carry needles, are unshaven " or even one that said "flared trousers and guitars" would arouse suspicion, then you know you will be in for a hard time if you have an insulin syringe. From experience look out for Thailand/Malaysia, Belize/Guatemala, Malawi/Zambia.

What I suggest is you always keep one vial of insulin on you, carry documentation of your problem, which should be translated into the language of where you may be going as not all border guards speak or read English.

Patients find the SOS bracelets useful and you can have the word "diabetic" translated into all common languages.

When the flight crew were looking uneasy when you were taking your insulin, you should just tell them very openly that you are diabetic and often they will be happily reassured.

Another gadget to use is one of the diabetic pens. These are preloaded with your insulin and you can adjust the dose easily. These look like pens and arouse less suspicion as there are no little vials, syringe and obvious needle.

Thanks to the action of the Consul you were alright but the problem with diabetes is that if you had begun to become low in sugar the first signs are irritability and aggression. If this had happened in an airport Police cell then I hate to think what could have happened, so always carry a supply of glucose with you to get your sugar levels up.

Finally it would be good to contact the British Diabetic Association and tell them your story, and if they haven't got a card to instruct truculent Customs and Immigration Officers of your problem then get them to make one.

Q. My girlfriend and I are about to embark on a five month backpacking and trekking holiday to India and China. I have a basic knowledge in medicine and would like to know if you could reccomend  a concise yet comprehensive book with reference to both emergency first aid and medicine for travellers to foreign destinations.

A. Recent research now shows that up to 80% of travellers will get some sort of medical problem. Fortunately most illnesses fall into the minor category, like sunburn or diarrohea. But if left either untreated or poorly managed a trip can turn into a nightmare.

In the countries you are visiting, most prescription meds are freely
available over the counter. Good news for you, but you need to know which ones to get when you fall ill.

So, I recommend either the really concise Lonely Planet guides, and they have one specific to Asia, or the bulkier but more thorough "Travellers Health" by Dr Richard Dawood.

Don't forget there's a mine of information you can pluck off the web if you are stumped for ideas when travelling, and a print of certainly is a lot lighter.

Q. I am going travelling for a year starting December with a friend.  I have had Ulcerative Colitis for 2 years and am on Balsalazide and Azathioprine.

I have been well and had no flare ups since the original attack.  I am hoping to stop taking the Azathioprine before I leave.

We are planning to spend most of our time in Australia, but will also be visiting Thailand, China, Vietnam etc so I am wondering what the implications are for getting medication, treatment if necessary and if there is anything in particular that I need to do in advance.  Also, will the various vaccinations have any conflicts with the medication I currently take?

Any help you could give me will be much appreciated


A. There may be a problem in having the shots you need for the trip.
Azathioprine is what is known as an immunosuppressant. This helps in the treatment of your condition, however it may interfere with the vaccination. All vaccines create an immune response to viral or bacterial components in the injected liquid. If your ability to create antibodies, which then later protect you, is decreased then you may not be fully immune to say Hepatitis A or typhoid. It would be more sensible to have the shots having stopped the azathioprine.

As your colitis is under control you should not experience any problems normally. But like any traveller the thing to look out for is of course good old diarrohea. So take all preventative measures and treat any case quickly with ciproxin. There is a rare problem with taking tablets like immodium or lomotil if you have colitis, and that is "toxic megacolon". So only consider these tablets to slow you down after a medical examination.

Q. Any tips for a diabetic about to go to Thailand for some trekking?

A. The travelling diabetic has to be aware of a few factors that can ruin their holiday. It starts with arrival at the airport in Thailand. If you are carrying syringes and needles with you it is a good idea to have a letter explaining your problem. I once met a diabetic that was kept overnight in the airport cells of a certain country as he had been reported by the in-flight crew as a potential drug abuser as they had seen him self injecting on the plane.

If the letter was written in Sinhalese, that would be even better. I believe the British Diabetic Association has a supply of these.

If you are insulin dependent then you may need to keep your insulin supply cool whilst in the jungle. There are cool packs you can buy to do this.

Finally, if you get any illness that may derange your blood sugar, such as diarrohea or other infections then monitor your blood glucose regularly and treat the illness quickly with appropriate antibiotics. Be prepared, take some with you. Ciproxin is probably one of the best broad spectrum ones going.

Q. We are returning to mainland Greece in mid May and I would like to prevent a recurrence of the problem I experienced last year of prickly heat/allergic reaction to sun cream. I am always very careful about spending time in the sun. I have typical English colouring, fair skin and mousey hair plus a tendency to eczema. Last year, as usual, I used a suncream for sensitive skins, limited my exposure to the sun but ended up with the most appalling itchy rash all over. It was difficult to tell if it was the sun or the cream. All I know was that I had to spend the whole holiday covered up, plastered in calamine lotion. Not a pretty sight. I tried to purchase a different sun cream at a local chemist but I think the damage was already done. Do you have any helpful suggestions?

A. Bad luck,

This is a common problem. We all read about and wisely act on the dangers of the sun's UVA and UVB radiation, but for many the creams can cause a problem. Prickly heat occurs when the sweat ducts of the skin get blocked, the sweat causes a bubble, that itches and the rest of the holiday can be spent in purgatory.

The key here is for you to wear loose cotton clothing that covers most of your limbs, and avoidance of the midday sun.

It is clear you are not after that tropical tan, so the clothes shouldn't be an embarrassment. Remember though that the UV rays can penetrate clothing, so watch out as you may still need a cream.

Some creams do cause problems, so try a few different ones until you have found what works for you.

Finally, any activity that makes you sweat more will increase your chances of blocked sweat ducts. Apply common sense. A desert camel ride versus lying by a shady hotel pool. You can see where I am coming from.

Q. Last October I had a malignant melanoma removed from my thigh. This resulted in me having plastic surgery and a skin graft. I am fully recovered now and subsequent check ups have been all clear. However , whenever I ask the consultant about going in the sun, I never seem to receive a straight answer so I wondered if you could enlighten me.? Do I have to keep out of the sun completely? Or can I be in the sunshine as long as I am covered up? Do I have to use a total sun block? Am I more prone to get another melanoma now?

A. There is evidence to show that you are more susceptible to another melanoma if you have had a first.

So in your situation I would do everything I could do to stay protected in the sun.

I would advise that you avoid the midday sun in all countries, this is where exposure to UVA and UVB is at its peak. When out at other times go for the strongest sun cream you can get. Factor 35 should be the minimum, with complete block on your nose and ears.

Classically melanoma can strike the fair skinned and red headed, but of course it can get anyone. Those with a high freckle count have been known to get it more too.

If you are ever worried about another spot, the warning signs are a change in shape of the spot. The edge will become irregular, losing all symmetry. The colour darkens from a blackish-brown to black, and it may bleed or itch. Show it to your doctor immediately, but it is wise to take a photo too, as this can be compared to any others done previously. What can confuse doctors as well, is the "amelanotic melanoma". A melanoma containing no melanin whatsoever, it is white and dangerous. But like all odd spots always take it to your doctor.

Q. We are travelling to Peru at the end of July and will be spending time in the Andes. Is there anything that we can do now to make us less susceptible to altitude sickness? We would hate to go all that way and not be able to do all we plan because we can't cope with the altitude. Also I am slightly asthmatic, in that certain things make me cough. Is it likely that my reaction could be more extreme at these altitudes?

A. The best way to avoid altitude sickness is to acclimatise slowly. If you are flying to Lima which is at sea level you will be fine. But if it's into Cuzco which is very high then you will be at risk. Do not plan anything too energetic for the first 2 or 3 days. Avoid smoking, heavy meals and excess alcohol. If you do get the symptoms of nausea and a terrible headache, then try to decrease your altitude. Though I appreciate this may be difficult if you are booked into a hotel for a while, it is the best way to cure it. If this is impossible, then a medication called acetazolamide works well to decrease the symptoms. Take 1 tablet 3 times a day whilst you are high up.

Altitude sickness can be fatal in extreme circumstances, when the lungs fill with fluid. So if you get extremely short of breath, with frothy sputum, then get straight to a hospital. Altitude will not affect or be affected by your asthma. In fact I bet with all that clean air up there, your condition may even improve.

Q. My boyfriend and I are currently planning a rtw trip taking in India and SE Asia but I am concerned that his nut allergy is going to causeproblems. Do you have any tips, and would it be possible for him to get an adreni-pen from our GP prior to travelling?

Also, I have a history of depression and panic attacks and although I don't want to get malaria, I do not want to risk taking lariam, what is the most effective alternative?

A. It really depends on how serious his nut allergy is.

If there is a risk of total anaphylaxis, where the lungs swell up and a fatality a possibility, then you must get one of the adrenaline pens before you go.

These are simple to operate and it would be advisable for you both to use one in a dummy run so in an emergency it's not the first time. So get a couple from your GP.

However if the allergic reaction is mild then often simple anti-histamines work well.

Nuts are used commonly in Asian cooking so learn the local words for "nuts" and "no" so you can use them when ordering from a menu.

As for your antimalarials. I agree, with a history of depression you should not take Lariam [mefloquine]. Fortunately now there is a better alternative called malarone. It's a daily tablet and as it only has to be taken for a week after leaving a malaria area you can use it in short blasts depending on where you are going.

Q. After long car journeys, when I tend to be the passenger, I feel lethargic and slightly nauseous for 24 hours, even with a good night's sleep before and after the drive. I don't get travel sick during the journey but find this after-effect very debilitating. Do you have any suggestions?Penny Munday

A. Travel sickness, like seasickness is most often due to the difference in stimuli between what the eyes are looking at and what the balance centres of the inner ear are telling us. When you try to read in a car, for example, your eyes are fixed on a point on the page. As the car turns corners the endolymphatic fluid in the semicircular canals, which is responsible for telling the brain which position the head is in, sloshes around these canals. The end result is a feeling of nausea as the eyes say you are in a fixed position, but the body is obviously moving.

To counteract this always look in the direction you are travelling and anticipate any turns.

In your case it may be better to drive, and certainly ever sit in the back of the car.

Finally exhaust fume poisoning can make you feel tired and nauseous, so check the exhaust is not leaking the carbon monoxide rich gas into the car as well.



   
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