I will be mentioning this again in my extended, illustrated Kilimanjaro and safari report. When you go to other countries, especially 3rd World countries where health and sanitation is not as good as in the "developed" world, you visit (or should visit) a travel medicine clinic. For Equatorial Africa, there are a number of immunizations you need, and since there is no vaccine for malaria, you need a program of prophylaxis, which consists of taking pills regularly for an extended period of time. The travel medicine folks offered 3 choices and reviewed most of the side effects. We chose 1 of them that seemed most benign, Doxycycline. This one is to be taken once a day starting a day or two before getting into the malarial area and continuing for 4 weeks after leaving the area. I wasn't too concerned about the side effects listed (I rarely suffer from side effects from any medicines), until I noticed that after the first week, my lower GI system was behaving slightly differently. Not much, but a bit differently. Then, after descending on summit day, I noticed that despite using lots of #50 sunblock, I had a bit of a sunburn (as one who grew up on "healthy tans" and now uses lots of liquid nitrogen in regular visits to the dermatologist, I worry about that). Hmmm, I recall something about sensitivity to the sun. So I finally got around to reading the pharmacist's sheet carefully. Unnnnnnnhhhhh, it says here a lot about increased sensitivity to the sun. And what's this about timing at least an hour before or 2 hours after eating anything? (after getting home and reading the Travel Medicine flyers, that one said "with meals" in direct contradiction to the pharmacist's sheet). Then there was something about interactions with an excessive amount of caffeine (hmmm, I was drinking multiple cups of tea and hot chocolate, and wait, what's this about interacting with large quantities of chocolate candy, my primary energy source when hiking up hills????). Well, no real intestinal upsets, but it says, don't take antidiarrheals that have bismuth (Peptobismol!) or with antibacterials (wait! they gave me Cipro, just in case!).
Moral of the story - don't just listen to the nurse at Travel Medicine, or even the doctor. Read everything they give you, plus the pamphlets that come with the prescription medicines and the pharmacist's flyer. Let them know about everything you take, including herbals, kinds of fruit you eat (grapefruit interacts with lots of medicines, it turns out), and even that you will be eating lots of chocolate and drinking tea, cola, coffee, hot cocoa, and other things having lots of caffeine. These things interact with lots of things, even stuff you think of as harmless.
Luckily, the worst side effect was the sunburn despite lots of sunblock (gee, who would have thought that "increased sun sensitivity" meant your SPF50 wouldn't be fully effective at 19,000 ft?). Well, lower GI softening is better than constipation, so maybe that's a benefit.
