Medical advice for travellersI have high blood pressure. Will the altitude in Tibet cause me any problems?
Q: I have recently been diagnosed with high blood pressure and blood cholesterol. These have been brought down to suitable levels with a beta-blocker and a statin. Otherwise, I am a reasonably fit 59-year-old male. I am not overweight and can walk up a hill at a smart pace without any discomfort. Am I okay to travel to Tibet because of the altitude?
Bill O
Dr Jules Eden replies: This may well be a close call. Don't worry about the statin; it just lowers the cholesterol and is fine at altitude. However, the beta blocker could be a problem. It reduces blood pressure by slowing down the heart.
At altitude, as oxygen levels decreased, your heart would compensate by increasing its beats-per-minute rate before other physiological changes happen. With a beta blocker, it cannot. The issue here is that you must really make sure you do the absolute minimum while you become accustomed to the altitude. It usually takes three to four days to acclimatise, but with the beta blockers give it at least five.
If you go for any trekking, take it really easy up the slopes. An alternative may be to switch to a different blood-pressure tablet. Try losartan, one of the newer ones that won't slow your heart rate.
Q: I have been diagnosed as having cardiomyopathy and have been prescribed enalapril, frusemide and warfarin. I attend The Doctors Laboratory in London on a weekly basis; they analyse my blood and advise me of the anticoagulant dosage of warfarin to take until the next blood test. How can I find a suitable clinic in Dublin, which I visit regularly, and other countries in Europe where I may be on holiday? It would need to take a blood test, then telephone the clinic in London with the results. They would then advise the dosage.
Donal McGovern
A: This is where the internet has been such a revelation, as a pure quick information source. Of all the search engines, I prefer Google, and after a quick search have come up with a list of private doctors in Dublin. Interestingly, the best list ison the US embassy site which acts as an information source for its own staff. Often, embassies and consulates will have the best and most up-to-date list of good local practices. So for trips farther afield, try the Foreign Office site for embassy numbers, call and ask for recommendations as to who to use locally.
The test you are having is called an INR. It is a measure of how much the warfarin has thinned your blood. It's a reliable test and used around the world. It may be easier, though, for your London clinic to tell you what dose to take if the INR comes in at certain levels. In my experience, if you are relying on the lab to call the UK clinic and them to call you, then there are too many possibilities for delay.
Q: Re Flying doctor, August 31: two of your answers contained references to 'a bacteria'. I hope that this was due to some enthusiastic editing of your original and not an indication that even the medical profession is incapable of recognising a Latin plural. Or am I being pedantic? If so, can you recommend a cure?
Ron Fairweather
A: I blame our failing education system! Gone are the days when every doctor required Latin to get into medical school. And so now a new breed of doctor has emerged with no idea of plurality, syntax or even punctuation.
Turning to more clinical matters, pedantry can be a small facet of obsessive compulsive disorder, something that is easily treated with an SSRI antidepressive.
Ask the flying doctor If you have any questions you want to ask Dr Jules Eden, email travel.doctor@theguardian.com, or write to The Flying Doctor, The Guardian, 119 Farringdon Road, London EC1R 3ER.
ยท Dr Jules Eden created E-med as an online support service for anyone who finds themselves a long way from a doctor's surgery. You can get free pre-travel information on any destination in the world. Log on and click on the Travel Clinic icon.
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