Dear Doctor Dysphoric:

Doctor,

I´m currently traveling in Peru. I was feeling fine when i was by the sea, but now i´m in a town which is at 11,000 feet and I´ve developed a bad headache. I´m also feeling a little nauseous and my extremities are a little tingly. What can i do to feel normal again?

Dizzy in Cusco
 

Hi,

Recently a Dr. told me that condoms, when used correctly, are 99% effective against HIV. How do you correctly use a condom? As I understand it, you squeeze the tip and roll it down to the base of your penis before sex. Am I missing something here?

Also, how easily can you catch HIV through oral sex? For that matter, which STDs are you most likely to catch through oral sex?

Thanks,

Randy
 

Dear Dizzy--

You have the classic symptoms of mild altitude sickness: dizziness, headache, nausea, and fatigue after sudden ascent to an altitude > 2500 meters. Perhaps you have already seen the 2001 review of altitude sickness in the New England Journal of Medicine (345): 107-114, July 14, 2001? If not, I recommend it as a summary of the pathophysiology and treatment of altitude sickness.

In short, the best way to get rid of you symptoms is to descend to lower altitude—e.g, get outta Cuzco, baby. If you want to stay, your body will adapt to the change in altitude over the course of several days. Do not ascend while you still have these symptoms.

In the future, you may want to do a little reading on the prophylaxis of altitude sickness with acetazolamide (Diamox), a water pill which has been shown to work for prophylaxis of altitude sickness. From personal experience, I believe the side effects of this medicine (mucho pee-pee and tingling in hands and toes) likely outweigh the benefit. Steroids are another option, but they have their own side-effect profile (e.g craziness, which you don’t need). There has been some experimental research on the use of Sildenafil(Viagra) for the improvement of exercise tolerance at high altitude. While this research might be of interest to you, it is not the standard of care, and I do not recommend using Viagra for this indication.

Get your butt to the nearest Farmacia and ask for “Calmante.” Analgesics, hydration, and rest will make you feel better until your body adjusts.

--Doctor D
 

Dear Randy--

All good questions. Unfortunately, I have to get through a stack of paperwork larger than that pictured on previous blog entry before I leave work tonight, then I need to go to gym.

Please refrain from sexual intercourse until I get back to you. I cannot be held responsible for those STDs you may acquire while I am at the gym.

--dysphoric (and randy too)
 

I have to say that that 2001 issue of the New England Journal of Medicine must have gotten lost in the mail. . . Thank you for your thorough reply. I am beginning to feel better so I think I will stay here for a little while longer. Also, I was amazed and delighted to discover that my hotel has the ability to pump oxygen into my room. They say it helps you sleep during your first few nights at altitude.
 

As instructed, i have abstained from all intercourse for the last 24 hours but i don´t know how much longer i am going to be able to keep this up. To make my question more specific, what can a man catch from a woman performing oral sex on him? And what can a man catch by performing oral sex on a woman? To reduce risks, what should I keep my eyes peeled for when I am with a woman for the first time?

Randy (but careful)
 

Randy--

I have forwarded your important question to Dear Doctor Dysphoric's new infectious disease consult. you won't be disappointed... Dr. Bugs and Drugs has had top notch training. I have no doubt that she knows oral sex in and out.
 

I can´t wait. This no sex business iz killing me!