Dear doctor

Q I am due to travel to New York for work in the next week and want to get hold of some cipro to protect me against anthrax. My GP laughed when I suggested he give me a prescription and said he'd be struck off if he handed out cipro to every patient with a nervous disposition. It's all very well for him to be so jocular, but I'm still worried and want to get hold of some. Can you help?

A Medics often turn a bit jocular in the face of a crisis - it's a coping mechanism. And though I'm not sure he'd actually be struck off for giving you some cipro, it was the correct advice according to the Public Health Laboratory Service (PHLS). The PHLS assures me - and you - that the risk is tiny and you shouldn't worry. If you come into contact with a suspect package, area or person and anthrax is subsequently confirmed, you will be given ciprofloxacin (cipro to friends) to prevent you contracting the disease.

If lots of people take cipro "just in case", resistant strains of anthrax will emerge which will prove more difficult to treat. The signs of anthrax are a blister which turns dark and ulcerated in the more common cutaneous form, or a flu-like illness and breathlessness leading to rapid deterioration in the rarer respiratory form. Try to put anthrax out of your mind and enjoy your trip. More information from PHLS on

Q I am 74 years old and have had a severe pain in my head for many months. I was told it was tension headache - I was very worried about my son at the time. But a new doctor in the surgery took a blood test and has rang me to say I must immediately start steroids to avoid going blind. I find this very alarming as I have never had any visual problems apart from wearing glasses for reading. I have also heard that steroids can be very destructive and would rather not take them. Is there any alternative?

A It is likely that you have a condition called temporal arteritis, also called giant cell arteritis. It is due to inflammation of the blood vessels that supply part of the eye and causes a pain on one or both temples, a sore scalp, pain when chewing and a general feeling of being under the weather. You may also have an associated condition called polymyalgia in which the muscles of your upper arms and thighs ache and are weak, so that getting out of a chair can be a huge effort.

Steroids are given in high doses until the symptoms subside, and this may take up to a year. It's true that steroids can cause mood changes, bone thinning, bruising, diabetes, and you wouldn't want to take them if you didn't have to. On the other hand, untreated temporal arteritis can lead to irreversible blindness. If the diagnosis is in doubt, you can get a second opinion, but where no doubt exists I'd go for the steroids rather than risk my sight.

Q I feel fine but a friend told me yesterday that I look yellowish. I feel that I always look a bit sallow in winter and am inclined to ignore him as I've an aversion to doctors. Could I be ignoring anything important?

A You could be fine, or you may be jaundiced. If you're jaundiced because you've got a stuck gallstone, then it may not matter if you ignore it. But you could be jaundiced and have a viral hepatitis which can be transmitted to sexual partners. So it seems to me that you have a responsibility to find out if and why you're looking yellow.

A simple blood and urine test will confirm if you're jaundiced and will probably be able to determine why. Jaundice is usually due to one of two problems: hepatitis, which is inflammation of the liver caused by drugs, alcohol or a virus; or it is due to blockage of bile as it comes out of the liver and gallbladder, which is usually due to gallstones and less often due to cancer of the pancreas which lies in that area. An ultrasound scan can usually determine the cause.

A yellowish tinge can also be due to kidney disease, some types of anaemia, eating too many carrots or a fading suntan. For the sake of a blood test and possibly an ultrasound scan, why not see your doctor and set your mind at rest?

Q I am plagued by aches and pains in my back and thighs which for years have been put down to arthritis. My cousin has very similar symptoms and has been told she has Paget's disease. What is it and could I have it too?

A Paget's often has no symptoms and is found by chance when you have an x-ray. It is a common condition affecting 4% of all over 40s and is due to increased bone turnover in areas such as the skull, spine and thigh bones. The level of enzyme alkaline phosphatase, involved in bone production, is raised in Paget's. This shows up in x-rays and blood tests.

A group of drugs called biphosphonates, such as Didronel, can be given orally or occasionally intravenously. They usually make the bone pain disappear within a few weeks. It's not usually inherited but it is common so you may have the same as your cousin. Ask your GP for x-rays, a blood test and referral to a rheumatologist for treatment options.

· 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 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.

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