YOU'RE trying to decide where to spend your next vacation . . . everyone in the family has had some input on their personal favourites . . . you've chatted with well-travelled friends seeking suggestions, read up on possible destinations, talked with your travel agent.

Yes, you're on the right track for people who consider themselves in excellent health. But if there are any medical complications, a family doctor in whom you have great confidence and trust could also offer some wise input. In fact, their advice could be life-saving.

Have you ever thought of asking them if they think Tibet's altitude is OK for your heart? How your disagreeable allergies or asthma might cope with a certain area, or if your cancer is in remission and not likely to cause complications?

Which is not to say what appears at the moment to be good health is any indication of what's ahead. Three of this journalist's closest friends all had at least one parent who lived to age 93 and came from families with incredible longevity.

Each felt certain they had inherited those genes and could fearlessly travel anywhere, eat anything with total abandon. All died the same year in their fifties of fast-acting rare cancers not diagnosed by overseas doctors, despite extensive testing and re-testing.

One had followed his humanitarian instincts and volunteered in Lithuania to help restore university education, libraries, etc. after the Russian occupation ended. He began feeling poorly, went to a local doctor who treated him for indigestion. Months passed, his health worsened, but after repeated doctor visits and testing, the diagnosis remained unchanged.

Finally, in great discomfort, he decided to fly home for a check-up and was diagnosed as stage five lymphoma. All totally missed in Lithuania. We'd all grown up together and were like family. My brother Jim and I visited him in Ohio where he was being treated, talked every few days by phone and one year and one-and-a-quarter million dollars of treatment later . . . and much suffering . . . he was gone.

"If only he'd come home sooner," lamented his US doctor, "there might have been time to do something in its early stages."

It certainly shouldn't come as a surprise that your own personal family history plays a major role in choosing travel destinations. Certain health conditions definitely impact on those choices.

Happily, great progress has been made in making travel more accessible to handicapped, even wheelchair-bound tourists, something we'll cover down the road in a future article.

Even those on kidney dialysis can participate in cruises which provide dialysis facilities on certain specific cruises. A fellow member of the Society of American Travel Writers needed such dialysis when he came to Bermuda for our annual convention in September 2001. I called him once I got home to check how he was doing with his very complicated list of ailments and he had high praise for the dialysis treatment he'd received while in Bermuda.

Probably an easy way to put this in focus is with some personal history. My family has a very unfortunate gene that causes instant death from heart attack in a very disproportionate percentage of its members.

BOTH my parents took a deep breath and were gone . . . my father far too young just dropping beside his car, my mother in the car starting out on a trip in apparent excellent condition when she said: "I don't feel right . . . I don't know what's wrong", and she was gone. Awful, traumatic to cope with.

My 36-year-old cousin was the latest victim, talking on the phone to a friend and suddenly there was silence. A favourite 48-year-old uncle died behind the wheel of his car, another had a heart attack at 46 . . . and so it goes on and on through our family tree.

So this spring when I casually mentioned to my doctor that we were thinking of taking a 14-day transatlantic repositioning cruise, his immediate response was: "Considering your family history, not until you take a stress test first."

It was a terrific buy on a very special small six-star ship with a stop in the Azores and Madeira, but all the rest of the time far from anywhere. This doctor is well-travelled, fiftyish and says he dreams of emulating our lifestyle when he retires less than a decade from now.

"But I just had a stress-echo a little over a year and a half ago, and passed with flying colours," I protested. He was insistent that it was in my best interest for protection and I eventually decided to go somewhere else instead because I feel the test itself is enough to induce a heart attack!

But he does make an interesting point. Unfortunately, almost every doctor I've interviewed on board various ships has told the same sad tale. Many seriously ill travellers, sometimes terminal, decide to take one last spectacular cruise.

On board Wind Surf the doctor told the story of a passenger with advanced colon cancer who haemorrhaged so seriously the ship had to be diverted to the Azores so he could be hospitalised. Not only is such an experience traumatic for the patient, it certainly traumatises the person with them.

There have been cases on larger liners where helicopters have evacuated passengers when close enough to a port. If you have any medical problems considered under control, it pays to check on available ship medical facilities before sailing off. Some are exceptionally well-equipped and I try to arrange an appointment to meet the ship's doctor and tour the facilities to pass that information on to readers whenever I'm cruising.

One that particularly impressed me with its facilities was Renaissance Cruises which unfortunately went bankrupt after September 11 when bookings totally disappeared and left it with eight new empty ships.

PRINCESS Cruises bought two of them, so I telephoned its pubic relations department recently to ask if it had maintained those excellent facilities after its purchase. I didn't want to write about Princess Cruises if it wasn't still there. Sounds like a reasonable question, don't you think? I found the availability of such a fine hospital set up a good selling point for the kind of older, affluent traveller its itineraries attract, and wanted to pass the word on.

Apparently, it thought I was some kind of corporate spy, acted extremely unpleasantly and was actually very rude. Its media relations person, Tori Benson, who knows I'm a long-standing member of the Society of American Travel Writers, said: "I don't care to talk to you about that." Her tone was so icy the phoneline was in danger of freezing. So apparently medical facilities on board are considered top-secret. One does wonder.

By way of contrast, not only is the ship's hospital aboard the Radisson Seven Seas Navigator a standout, but so is its very personable staff of a Polish doctor and gemutlichkeit Austrian nurse on staff during my cruise.

Very well equipped, it had sophisticated laboratory equipment that could test patients' enzymes after a suspected heart attack, give patients an electrocardiogram, oxygen, X-rays and an emergency surgery.

There were two units of intensive care rooms. It was even equipped with two isolation and contagion rooms and also built-in beds that could be lowered in an emergency.

With all the problems other ships have encountered with Norwalk virus and other outbreaks, this ship isn't taking any chances. The doctor even showed me the fumigation equipment.

"We visit exotic places . . . one must be prepared." He agreed in today's complicated world, ships could be a target.

They'd had a special group that came on in wheelchairs and another time a group of ten passengers on kidney dialysis.

"We have lists of doctors everywhere and we even practise helicopter medical evacuation." Very impressive facilities and, of course, spotlessly clean.

Bermudians have seen this highly rated ship in port all season. It carries 480 passengers who are used to the best in service and facilities.

And yes, ships' doctors are used to handling crises. One recalled an incident in 1998 when a crew member from Lithuania was given drugged tea in Istanbul that knocked him out. The perpetrator stole his jacket and left him outside in the cold where he got hypothermia.

On 148-passenger Wind Spirit, the temporary doctor, who spends most of his year in a stateside emergency room, admitted there were obvious limitations.

AN older passenger had all the symptoms of a heart attack on the transatlantic crossing and "all I could really do was keep her comfortable and monitor her condition. There would be no possibility for open-heart surgery if needed." She turned out to be okay and was still continuing on the one-week segment when we joined the ship in Lisbon.

Next week we'll finish up with how you check on a cruise ship's health, cleanliness and sanitation ratings . . . what's happening with all those ship-board epidemics that have received so much publicity and how to avoid problems and cope with them when they happen.

We certainly learned first hand early on how to cope on a Turkish cruise ship more than 35 years ago. On a day when temperatures reached 100 degrees, a picnic lunch prepared the night before had been taken ashore the next morning and set up at a picnic site.

I'm told the menu included a chicken sandwich with mayonnaise and other potentially deadly items when not refrigerated. The sight of condensation inside the plastic containers sitting in full sun for many hours made me decide to opt for coke in a bottle without ice. Jim ate an apple.

Approaching the dock that afternoon to reboard the ship, people began collapsing, falling to the ground. It was an awful sight and unhappily Jim was among them. Altogether 90 people became desperately ill and botulism food poisoning was feared.

The most serious were put in the ship's hospital and because he had such a high fever, Jim was given ice cubes there to suck, which he refused when he saw dead flies embedded in the ice.

The young woman doctor was in her infirmary preparing an antidote shot for those afflicted. Soon she started making the rounds with a large container that had a tube connected to an old-fashioned, large glass hypodermic needle. I watched in one doorway as she injected it into a sick ship's officer, lightly wiped off the needle and injected it in the next patient.

By this time my very weak brother had insisted on personally seeing if any sterilisation equipment was being used, so he struggled into her lab with me and viewed the pristine, new, unused steriliser. No, she didn't intend using it she insisted . . . it was unnecessary. And incidentally, she was a recent medical school graduate. So Jim wisely refused the shot.

MEANWHILE, I spoon-fed tea to Jim and almost instantly one could hear it gurgling through his system and immediately out. It was a nightmare. He lost nearly 25 pounds in eight to ten hours, was too weak to go ashore in Bodrun and remained that way for months. Stateside doctors said he had a super immune response to what they thought was shigella.

After that experience, our family doctor insisted on sending us off on far-flung adventures with disposable packets of needles if ever again we encountered such an experience. Happily, they were never needed, but with the growing drug culture, we stopped carrying them for fear customs inspectors might misunderstand.

But on our last around-the-world trip, the immunisation centre of our hospital insisted we carry a sealed packet of them with their official seal and a covering letter in case of emergency. In many parts of the world, needles are used over and over again without being sterilised.

Next week: Ship-board viruses and other problems