Q: I have recently undergone a knee replacement on both knees. It is three weeks since the operation, but I have been invited skiing in December. Will I be fit enough by then?
John Hopcroft
Dr Jules Eden answers: In December, you are close to the time when you should be fine to ski, but there are a few mitigating factors. You must make sure you are as close to your normal weight as you can be, to reduce stress on your knees. Another factor is what we call quadriceps wasting. These are the muscles in the front part of your thighs that are used a lot in keeping your knees flexed. If the condition that necessitated your knee replacements has let these muscles in your leg waste away, you will need some good physiotherapy to build them up again.
December may be a little too early to get back to a full-on skiing trip, but you will probably be able to go on long, flat, smooth runs with as little turning as possible.
Q: I am going travelling for a year, starting in December. I have had ulcerative colitis for two years and am on balsalazide and azathioprine. I have been well and had no flare-ups since the original attack. We are planning to spend most of our time in Australia, but will also be visiting Thailand, China, Vietnam etc, so I am wondering what the implications are for getting medication, treatment if necessary, and if there is anything in particular that I need to do in advance. Also, will the various vaccinations have any conflicts with the medication I am taking?
Isabelle Gascoigne
A: There may be a problem in having the shots you need for the trip. Azathioprine is what is known as an immunosuppressant. This helps in the treatment of your condition, but it may interfere with the vaccination.
All vaccines create an immune response to viral or bacterial components in the injected liquid. If your ability to create antibodies, which then later protect you, is decreased, then you may not be fully immune to, say, Hepatitis A or typhoid. It would be more sensible to have the shots having stopped the azathioprine.
Like any traveller, the thing to look out for is diarrhoea. So, take all preventative measures and treat any case quickly with ciproxin. There is a rare problem with taking tablets such as immodium or lomotil if you have colitis, and that is 'toxic megacolon'. So only consider these tablets to slow you down after a medical examination.
Ask the flying doctor 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.
· Dr Jules Eden created E-med as an online support service for anyone who finds themselves a long way from a doctor's surgery. You can get free pre-travel information on any destination in the world. Log on and click on the Travel Clinic icon.
