I am terrified of flying and have been taking amitriptyline for a number of years for chronic headaches. I have to fly this month, and my doctor has prescribed diazepam 2mg. What will it do, and what are the side effects? Should I stop taking the amitriptyline so as not to have too many drugs in my system?
Dr Jules Eden writes: Diazepam, or Valium as it is commonly known, is a benzodiazepine that decreases anxiety. Depending on exactly how terrified you are of flying, it can be a good or bad drug. If you are mildly anxious, enough to sweat and feel your heart rate increasing, then 2mg will be appropriate, but if your fear is so bad you leave nail marks up the aisle as you are shown your seat, then you may need a stronger dose or even try Xanax, which can be better in acute anxiety.
There are issues of dependence with any benzodiazepine, so do not make a habit of using them too often. If this is a concern, then a beta blocker called propranolol can be good - 40mg is the best dose -but it should never be used by an asthmatic due to its side effect of bronchoconstriction. There's no real need to stop the amitriptyline in your case, as the diazepam will only be a one-off each way with flying.
My son wants to learn to dive so I am taking him to the Red Sea. Unfortunately, he has had both ears pierced (four in one ear and three in the other). He also has a couple of bars with studs either end through the bridge of his nose, a ring on his bottom lip with two spikes either side, and he has started to get an upper-body tattoo done. Will there be health problems, and what will the diving instructors make of his appearance?
Luckily for your lad, there is no real problem with all the rings, bars and studs. They should not affect equalising or breathing through the regulator as long as the metal sits flush against the rubber of the mouthpiece. The only piercing that would be a problem is something that stops him adequately squeezing the nostrils closed. This is the commonest act needed to equalise the ears and sinuses, whether diving, snorkelling or even descending on the plane on the way to his destination. So if he is about to get a bolt through both lower nostrils, stamp that parental foot down!
The upper body tattoos, though, could be an issue if they are freshly done and he has to wear a tight, chafing wetsuit. I suggest he leaves it two or three weeks after a major piece of skin artistry for the inflammation to subside or it may be too painful. I don't think there should be any increased infection risk after the metalwork and needlepoint with diving as compared with any other day-to-day holiday activity. Just take all the usual precautions, and if any site starts to get a bitgammy, then rub some antibiotic cream on the area.
Luckily, dive instructors are a fairly non-judgmental lot, so he should be fine. If you are worried, get him to call in to Diving Leisure London in Battersea and ask for Paul Toomer, who will welcome him like a long-lost brother.
· 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.
