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 to make us less susceptible to altitude sickness? I am slightly asthmatic; will the altitude make it worse?
Dr Jules Eden replies: 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 two or three 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. If this is impossible, then acetazolamide works well to decrease the symptoms. Take one tablet three times a day while 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 be affected by your asthma. In fact, I bet with all that clean air up there, your condition may even improve.
Last October, I had a malignant melanoma removed from my thigh. Should I 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? And am I more prone to get another melanoma now?
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. Avoid the midday sun in all countries - this is when exposure to UVA and UVB is at its peak. 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, the red headed and those with a high freckle count, but of course it can get anyone. 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.
· 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.
