Cold comfort
Q My seven-year-old son recently developed pneumonia from what seemed to be an ordinary cold. This developed into empyema and he underwent an operation. He is now, thankfully, OK. Is there anything we could have done to prevent it?
A How frightening for all of you. Over 100 bacteria and viruses can cause pneumonia and the viruses aren't touched by antibiotics. It can be easy to miss pneumonia as a doctor, and even easier as a parent. A chest X-ray helps to make the diagnosis and in hospital blood and sputum samples are sent off for analysis. But you wouldn't want to X-ray every kid with a nasty cough and cold, or start taking blood from them. The average school child has five significant cough/colds per year, yet pneumonia is relatively rare.
The signs to look out for are a very high fever (over 38C), a severe cough and ill health, which get worse over 48 hours instead of gradually improving. Breathlessness is also a danger sign and requires immediate medical attention. An empyema is a serious complication of pneumonia in which pus collects in the space between the ribs and the lining of the lungs. Prompt diagnosis and treatment of pneumonia probably does lessen the risk of an empyema but it doesn't preclude it. You obviously acted promptly enough to ensure that he is now well again.
Pregnant pause
Q I am five months pregnant with my first baby and would like to go on one more long haul trip before I have the baby - preferably to India or the Far East. Everyone's been telling me not to, but is there any good health reason against such a trip?
A Pregnancy is not a reason to give up the exciting things in life, including sex, travel and the odd glass of wine. You are in the middle third of pregnancy - the best time to travel as the risk of miscarriage is now very small and labour is unlikely before six months. You will probably have stopped feeling sick, but not started feeling huge yet. So go for it, but with a few reservations.
You are limited when it comes to jabs as all "live" ones, such as yellow fever, are out and even "killed" ones, such as typhoid, are dodgy. Your choice of anti-malarial tablets is also limited (chloroquine and proguanil are OK and mefloquine is probably OK at your stage). Be careful to avoid sources of infection such as hepatitis and typhoid by only drinking bottled water. Hepatitis E - transmitted in contaminated food - is potentially very dangerous to pregnant women.
Airlines won't want you on board after 36 weeks of pregnancy - some even draw the line at 28 weeks. Wear support stockings on the flight (but don't take aspirin) as your risk of deep vein thrombosis is slightly increased. The Royal College of Obstetricians publish a useful leaflet called Travelling in pregnancy (tel: 020-7262 5425).
Skin deep
Q I have psoriasis on my arms, chest and knees and have been told that sunshine helps. But during the brief spell of sunny weather recently, I sat in my garden most of the day and got quite burnt. The patches of psoriasis are worse than ever and some new ones have come up where I got sunburnt. Why is this and should I avoid the sun in future?
A Most people do find that their psoriasis improves in the sun, but some get worse. New patches of psoriasis can spring up in any part of the skin that is damaged. If you cut yourself, or have an operation that results in a scar, psoriasis can develop in that place. You've probably got some new patches where you were sunburned and the skin blistered. You should certainly avoid getting sunburnt in future - psoriasis is rarely a life-threatening condition, but skin cancers can be. And if your psoriasis flares up in the sun, it makes sense to continue to enjoy the sunshine but cover up and get some shade.
· These answers are intended to be as accurate and full as possible, but should never be used as a substitute for visiting a doctor and seeking medical help. If you have a question for Dr Robinson, email drann@dircon.co.uk or write to her c/o The Health Editor, The Guardian, 119 Farringdon Road, London EC1R 3ER. She regrets that she cannot enter into personal correspondence.
