A Question of Health

Flying's a pain

Flying's a pain

Q. When I travel by air, I always develop a severe headache during or immediately after the flight. Paracetamol lessens the headache, but does not usually get rid of it completely, and I am usually OK the following morning. I am 55 (female), I always drink lots of water and this has only happened during the past 10 years. Any suggestions how to stop these headaches?

A. This could be an unusual form of migraine, triggered off by changes in the pressure of oxygen that you experience in the aeroplane cabin. Migraine headaches can be triggered off by a number of things. The best-known triggers are bright lights, certain foods (such as red wine and caffeinated drinks), stress and hormonal factors. But changes in oxygen and barometric pressure can act as triggers for a small number of people. I would be interested to know if you get migraines in any other situations, or if you have a family history of migraine. You might want to discuss with your doctor the possibility of taking two doses of a drug called acetazolamide (known as Diamox) - one tablet the day before you fly and a second on the day of the flight. This drug is used by high-altitude mountaineers to prevent high altitude sickness, and it has also been successful for people who have migraines triggered off by altitude changes. Another option would be to use a standard migraine treatment, such as sumatriptan, to try to abort the headache as soon as it begins. The "triptan" familyincludes seven different drugs. Most of them are available as tablets, but two can be taken in the form of a nasal spray. They all require prescriptions from a doctor. One final piece of advice: absolutely avoid alcohol on the aeroplane.

Photographic eye

Q. In several of some family wedding photos, our 15-month-old son seems to have one "red eye" and one "white eye". We haven't noticed anything wrong with his vision, but are worried about this. Could this just be something to do with the way the photograph has been processed?

A. A "white eye" in a photograph may just be caused by the angle at which the photograph was taken. But it may also be caused by something within the eye which is preventing the flash from getting to the retina at the back of the eye. Even if the eye looks fine to you when you look at it, it is very important that your son is examined urgently by a children's eye specialist. There is a rare condition called retinoblastoma, which causes the pupil to appear white. If your son does turn out to have this, the sooner that he is treated the better. Retinoblastoma is an unusual eye tumour that only affects about one in 20,000 babies. Early diagnosis is essential to ensure the best possible outcome. Another possible cause of a "white eye" in a photograph is a cataract. Early treatment of these, too, is important.

Right to know

Q. I had a kidney removed 18 months ago, and it was discovered at the time that the cancer had spread to my lungs. I know my "average" life expectancy is about four or five years, and I have asked my oncologists details of what fatal symptoms might conceivably end my life. They are not willing to tell me, arguing that I might live a normal lifespan, and that if the worst came, I could do nothing about it anyway. I feel a need to talk about the subject with friends and possible future carers. Then, since I have no symptoms at present, I could put the matter on one side and get on with my life. Can you tell me where to go for such information?

A. Doctors sometimes don't like to talk about death and dying, although oncologists (cancer specialists) are probably better at it than most. I'm, therefore, a little surprised to hear that you had so little success when you tried to discuss this with your oncologist. Perhaps the oncologist feels that talking about fatal symptoms will make you feel unnecessarily pessimistic about the course of your illness. But if you need to talk about how the cancer will affect you if and when it reaches an advanced stage, it is only right that you be introduced to someone who can help you. I would suggest that you ask to talk to a counsellor or nurse in the oncology department who has experience of palliative care - treatments that are used to provide symptom control and comfort, rather than cure. Because the cancer is in the lungs, this might mean you will develop breathing problems or shortness of breath. But terminal cancer can cause a wide variety of symptoms, and each patient has unique problems. I suggest you get a copy of the booklet Dying with Cancer, published by CancerBacup ( www.cancerbacup.org.uk), whichhas a helpline - 0808 800 1234 - staffed by specialist cancer nurses.

HAVE YOUR SAY: READERS WRITE

MH from Berkhamsted thinks £10 is a small price to pay for non-smelly feet:

I must give an unqualified vote of approval for PediTech. I have now been using it for three years and it really does work. Yes, the spray looks very small for £10, but it lasts for several months because after the first week of intensive treatment, you only need to spray about once a week. I haven't found anything else so quick and easy, and, in my experience, washing just isn't enough. I would have needed to wash my feet three or four times a day to keep the problem under control.

Send your questions and suggestions to A Question of Health, 'The Independent', 191 Marsh Wall, London E14 9RS; fax 020-7005 2182; or e-mail health@independent.co.uk. Dr Kavalier regrets that he is unable to respond personally to questions