I have recently spent six months in South China where I developed a pain in my right hip which spread to my knee. The left hip and knee soon followed suit but not quite as bad. I also have pain starting in my elbows. Any ideas?
Carl Albutt
Dr Jules Eden answers: If you are young and fit and below the average age for osteoarthritis, and with no family history of rheumatoid arthritis, then there really is only one thing left. It's called reactive arthritis.
According to the Arthritis Research Campaign (01246 558033, Arthritis Research Campaign), 'Reactive arthritis normally occurs as a result of bacterial infection, most commonly as a result of food poisoning, flu, streptococcus (sore throat/tonsillitis) or sexually transmitted infections. Classic symptoms are the swelling of fingers and toes ("sausage digits") and extreme fatigue and joint pain. Treatment normally involves a course of antibiotics to treat the infection, and anti-inflammatories. Further treatment in the form of steroids and immuno-suppressants may be required for cases persisting over six months.'
ARC produces a free leaflet on reactive arthritis which can be ordered from their website or by phone.
Q: I have won a free holiday to Barbados, but since September 11 I am petrified of flying. What can I do to overcome this?
Jennifer Williams
A: Effective long-term cures are available, but they can take a while. They mainly involve psychological re-training in which you sit in a flight simulator and learn deep-breathing exercises.
If you are looking for a quick, temporary fix, there are medications you can take to calm you down. Some people take the beta blocker propranolol, which stops your heart from racing and keeps you calm in the wait before the flight. Others use diazepam. A 2mg dose can take the edge off your fear, or 5mg for more sedation.
Q: On holiday I am bitten by every blood-loving insect, but my wife escapes with almost no bites. Worst of all is my reaction to the bites - this year my left calf swelled to the size of two after a couple of bites, despite taking antihistamines throughout the holiday. Why does this happen?
Keith Hibbert
A: Various theories have done the rounds as to why only you should get bitten, including body and blood temperature. Apparently some mossies like us to be more chambre than chilled, like a good claret.
My advice is to try something like garlic capsules or some of the vitamin B compounds. These can be excreted in the sweat and make you far less palatable. As for what to do to prevent the massive reactions after a bite, you should try something a bit stronger than over-the-counter antihistamines, such as steroid tablets.
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.
