Dr Fred Kavalier: A Question of Health

How can I combat stiffening joints? First thing in the morning, I can barely get out of bed and nearly all of my joints are stiff. It is quite painful until I get mobile. I almost feel I need a walking-stick to get going. The problem quickly disappears within an hour or so, but comes back if I sit down again. I walk two hours a day.

Morning stiffness

How can I combat stiffening joints? First thing in the morning, I can barely get out of bed and nearly all of my joints are stiff. It is quite painful until I get mobile. I almost feel I need a walking-stick to get going. The problem quickly disappears within an hour or so, but comes back if I sit down again. I walk two hours a day.

Joint stiffness is a symptom of all types of arthritis. When it occurs first thing in the morning, it raises the possibility of rheumatoid arthritis. The other common symptoms of rheumatoid arthritis are joint pains and swelling. Rheumatoid can affect many joints, but it often involves the hands (particularly the knuckles), the wrists and the feet first. Later on it can affect the shoulders, elbows, knees and spine. People with the condition often feel unwell and may have a mild fever and anaemia. You are more likely to develop rheumatoid arthritis if you are a woman. It is worth seeing a specialist, who can perform specific tests to confirm the diagnosis. To find out more get in touch with either Arthritis Research Campaign, PO Box 177, Chesterfield, Derbyshire S41 7TQ, www.arc.org.uk, or Arthritis Care, 18 Stephenson Way, London NW1 2HD, freephone 0808 800 4050 (12-4pm Mon-Fri), www.arthritiscare.org.uk.

A question of safety

My wife is thinking about having laser surgery to correct short-sightedness. She has reservations, particularly about safety. She is thinking about going to Boots, which boasts a unique laser-tracking technique, or perhaps Optimax, which is doing an attractively priced special offer at the moment. Any advice?

Laser treatment for short-sighted eyes is big business, and several major players (including Boots) have moved into the market. There are two main kinds of surgery – photorefractive keratotomy (PRK) and laser-assisted in situ keratomileusis (LASIK). In addition, it is possible to have non-laser microsurgery to correct sight problems. Each of these has its advantages. Microsurgery, for example, is less likely to result in worse vision, compared with PRK and LASIK. All of the methods have now been used on thousands of patients, and the vast majority are satisfied with the result. No one will guarantee a successful result, and there remains the possibility that your wife will still have to wear spectacles even after surgery. Long-term studies of PRK have shown that about two-thirds of patients achieve excellent vision without spectacles (6/6) after surgery. About 90 per cent are able to see well enough to drive without wearing glasses. A small number of people may end up with worse vision after surgery.

Ex-smoker excluded

I suffer from COPD (chronic obstructive pulmonary disease), which developed in 1998, following a bout of pneumonia. I had given up smoking at that time for four years. Because I was a smoker, I feel that I have been written off by my doctors. I now use three different inhalers and have quite severe shortness of breath. Why are doctors so unsympathetic to people with smoking-related diseases?

COPD is rare in non-smokers, but common after years of inhaling cigarette smoke. I think you have been unlucky in the attitude you have found in your doctors. Many doctors and nurses are anxious to support and help ex-smokers. Smoking damages lung tissue, and this damage can progress insidiously for quite a long time before symptoms become apparent. Once the damage reaches a certain level, however, the body's ability to compensate is limited and this is the reason for the apparently sudden onset of symptoms after a bout of pneumonia. If your breathlessness is getting worse, you should be reassessed by a specialist.