Health News Blog provides coverage of current health news.

Roaming through the valleys of the Swiss cantons of Valais and Graubuenden, bright with the autumn sun and a riot of colours, the happy wanderer will find not only hedgerow after hedgerow of wild rose hips, but also many bushes replete with sprays of barberries. Of course, barberries grow in other areas too, but wherever they are, most people go past the wild fruits without realising that they have wonderful healing powers. The clusters of these red oblong berries are a delight to the eye and, together with autumn flowers and leaves, make a beautiful bouquet. Still, few people are aware that these berries can be eaten and are, in fact, one of the best nerve tonics available. No other wild berries are as rich in vitamin Ñ and many people suffering from ‘nerves’ could, on their walks in the country, benefit enormously by picking some and chewing them slowly before swallowing them. A general checkup of the population would no doubt prove that many people nowadays need such a tonic.

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Finally, what of the end of his fertile period? Old father time is an archetype of the past, present and future. Men can father children in their 70s and it is less natural to cut off a man’s fertility than a woman’s, that will in any case fail. Post-vasectomy counselling is not as widely available as it should be and regrets can linger.

As a last insight, one man spoke about withdrawal, describing it as ‘Terrible, doctor.’ Then he thought a moment, and added, ‘Actually that is not quite true because we used it while I waited for the results of the specimens after vasectomy. That was really our last excitement.’ Excitement and terror are closely linked. Excitement is easy to admit. Terror less so, but what was shared here was a tinge of sadness for his lost reproductive powers.

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Mr and Mrs E., a wealthy Indian couple, had been trying to achieve a pregnancy since their arranged marriage two years previously. Mrs E. was frightened and withdrawn at her first visit to the infertility clinic at the hospital, but seemed to be somewhat relieved to find a female doctor present. Mr E. gave the history and spoke for her. They adhered to all the investigations and treatment regimes with precision. She was diagnosed as having polycystic ovarian disease, and underwent a year of gonadotrophin therapy to induce cycles of ovulation, but she still did not become pregnant. Only on one occasion did the doctor manage to examine Mrs E. on her own. She hinted at her despair about her failure to conceive, and at the lack of fun with sex, but her allegiance to her upbringing and to her husband prevented her from letting go of any of her own feelings.

Several times on visits to the hospital, tears would appear but they would be stifled by her husband’s words, ‘Don’t worry, she will be all right soon.’ They were both sad when it was agreed that treatment should stop, but the doctor was again told not to worry as they would be fine. The only treatment left to them was to consider in vitro fertilization, where the fertilizing power of the sperm could be studied as well as ovulation. This idea must have posed difficulties for Mr E. but he could not share them with any member of the clinic staff.

Several months elapsed before Mr E. telephoned to say that they would like a private referral to be admitted on to the assisted conception programme at a nearby centre: he asked for it to be done immediately because he had got his wife in the mood for it now. An offer to come and discuss it again was firmly but politely refused.

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Sometimes the ambivalence can be due to a conflict between what the woman wants and what she ought to do. She may be subject to the pressure of others and fear criticism. She may use the abortion clinic for permission to continue with the pregnancy.

Miss D. was 25 and lived with her boyfriend. She had become pregnant for the second time, having had an abortion at 19. The doctor asked, ‘You want an abortion?’ She said, ‘No, I don’t really.’ She went on to reel off a list of reasons, many of them financial, as to why she could not have a baby. The doctor pointed out that she had given some very reasonable reasons for requesting abortion but had not said anything about her own feelings. She continued in the same vein. Recognizing her defences, the doctor tried safer ground and asked how she felt about her previous abortion. She had felt awful afterwards, as she had wanted the baby but could not have it. She was only 19 then. And now? She felt she was the right age but she and her boyfriend were in debt and lived in one room. The doctor said it must be sad to have an abortion when you really want a baby. At this point she burst into tears. She agreed she wanted this baby but felt she could not have it in her present circumstances. She wanted more time to think. She came back a few days later. She had talked to her boyfriend who was delighted at the thought of having a baby, and her parents were going to help out with the money problems.

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Sterilization is only for those who are sure that they want no more children. This is the ultimate in medical interference. An operation, sometimes under general anaesthetic, involving deliberate damage to the internal or external genitalia. From this, there is no going back, and all patients are counselled that reversal operations rarely succeed. Some pain and discomfort is to be expected, and even laparoscopic techniques carry a risk of future gynaecological problems. The first decision each couple have to make is, which one for the ‘chop’? Even with the most loving, sexually compatible and stable couple, this can be a difficult decision. There is an element of self-sacrifice here, which may be denied, but is present, nevertheless. One will be damaged, deprived of the ability to make a child, and one will not. One will have to come to terms with this personal loss, which is very different to the couple accepting that there will be no more children in this unit. It is common for the after-effects of sterilization to resemble grief, muted and unconscious though this might be. Grief for the damage, for the ending of fertility, for the children who might have been, but now never will be. The aim of sterilization counselling is to help the couple understand these feelings, and to filter out those for whom the decision is pressurized, or ill understood.

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It is perhaps inevitable that the doctor identifies or becomes identified with the medical methods of contraception so that when they me rejected he or she feels rejected too. This can lead to a feeling of uselessness and inadequacy with a sense that there is nothing to offer the patient. In this situation there is a risk of a retaliatory response, either dismissing the patient or attempting to impose a method against her wishes. In that case contraceptive pills are likely to be lost, intrauterine devices pulled out or the patient fails to return.

In these days of clinical audit, when successful contraceptive practice is measured against a fall in the number of terminations, the doctor may feel that all unintended pregnancies must be stopped. Acceptance that not all such pregnancies can be prevented nor every child a wanted one is something the doctor will need to come to terms with. Helping a woman to delay her next child by a few months may be a major achievement, especially if she is struggling with serious internal conflicts or a chaotic lifestyle. Taking time to create a relationship of trust and understanding, rather than one of nonproductive authoritarianism, may well pay dividends in the long run, and the doctor should not feel too much of a failure if there are some contraceptive mishaps along the way.

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Vaccination

Some people react to the sera on which immunising vaccines are cultivated. These have been greatly purified and refined, and adverse reactions are rare, but it is worth asking your doctor what the base of any vaccine is before it is given. Horse serum and eggs are sometimes used, for instance, and might affect you if you are sensitive to these. For advice on babies and immunization.

Anaesthetics

It is known for people to have adverse reactions to anaesthetics more commonly to general anaesthetics than to local anaesthetics. A surgeon or anaesthesist will usually check with you before any procedure whether you have any history of allergy or sensitivity, but make sure they know if you have such a history. Local anaesthetics are less hazardous – opt for a local, rather than general, anaesthetic if a choice is offered. If you have already had an adverse reaction, you can be tested in advance of any operation to see what chemical you react to, and a more appropriate mix of drugs chosen for you. Your GP can contact the National Adverse Reaction Consultancy Service (NARCOS) which is a specialist advisory service.

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Tap AC Filters

AC filters are available which fit on the end of a tap, or which are simple to plumb in to the sink top tap inlet pipe. They provide water on tap, at normal flow-rates. They are cheap, more convenient often than jug filters, and avoid any of the need to be careful about bacterial hygiene that jug filters involve. They are portable and can be taken with you if you go out or away. They cost between £11 and £90. Filters needs replacing every one to four months and cost between £8 and £19. They can be cheaper to run than jug filters. The quality of water is comparable to jug filters, and less pure generally than plumbed-in undersink AC or KDF filters.

Jug Filters

Jug filters cost between £10 and £20. A plastic container holding an activated carbon filter cartridge sits on a glass or plastic jug. You pour water through the tap container and it collects in the jug below.

Jug filters reduce the level of chemicals and metals in tapwater. They do not remove them completely, but people using them say that they do make a real difference.

You need to change the filter cartridge frequently – every 60-110 litres (13-24 gallons), or every month or so. If you live in a hard-water area, it will last less long than if you live in a soft-water area. Some jugs have a change-filter indicator to remind you when to change. The replacement cartridges cost between £2.50 and £3.50 (at 1992 prices). This can mean an annual running cost of £30-40, which is much cheaper than buying bottled water.

You need to take care not to allow bacteria to grow in the jug. Jugs and reservoirs are best cleaned weekly; filtered water should be kept in a fridge (best decanted into a bottle to save space). If water has stood in a jug for some time, it should not be used or it should be boiled before use.

The advantages of jug filters are their low initial cost and their flexibility – you can take them with you to work or if you visit or travel. You can buy filter systems with glass jugs if you are sensitive to plastic, and some filters will reduce nitrates significantly, although, again, not completely.

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For people who are allergic to inhaled particles which collect in dust -such as house dust mites, moulds, animal and pet debris, or fibres such as cotton or wool – using a filtration vacuum cleaner can make an enormous difference. For more information on detecting and avoiding allergens.

Conventional vacuum cleaners, even the most efficient, blow a share of dust and particles back into the room. Tests have shown that they actually increase the level of airborne particles in a room which explains why so many people with allergies feel worse during and after vacuuming.

Filtration vacuum cleaners, often called ‘allergy vacuum cleaners’, use a special filter which takes out virtually all particles of major allergens. Tests by Which?, by Good Housekeeping and other independent bodies, have shown that the two market leaders, Medivac and Nilfisk, both filter out over 99.9 per cent of particles down to 0.3 micron (three-hundredths of a millimetre) in diameter. So virtually no dust is blown around while using the machine, and allergens can be removed from sites where they have collected, such as beds, carpets, curtains or furniture, without dispersing them into the air.

These cleaners are expensive compared to other vacuum cleaners (see below) but people who use them say they would not be without them. Not only do they make cleaning possible in the environment of the highly sensitive with minimum dispersal of dust, but they reduce progressively the level of old or dead allergens collected in furniture, furnishings and bedding.

Most people who have such a machine report that their effect accumulates as time goes on and that they clear out the environment progressively. More than any other product designed to help people with allergies, these cleaners receive shining endorsement from their users. If you can possibly find the money, they are one item really worth buying.

There are two market leaders whose performance is measurably superior to other makes – Medivac and Nilfisk. There are some differences between them, notably price, the Medivac being more expensive (at over £300 at 1992 prices) than the Nilfisk (around £270). They are both canister models on wheels. The Nilfisk is lighter than the

Medivac, but it is made of plastic rather than metal, and if you are sensitive to plastics, the Medivac is preferable. Medivac and Nilfisk both provide efficient service and spares backup.

At the time of writing, Medivac is introducing a new lightweight model at a considerably reduced price. It has similar filters and performance characteristics to the original model, according to the manufacturer, but is not made of stainless steel. It is called the Medivac Lighterweight cleaner. We have no user reports to date, but if Medivac’s claims are correct, it should be the most competitive filter cleaner available for people who do not have to have a metal version.

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Any symptom can result from reaction to things used in connection with sex and contraception, including the classic symptoms of allergy, such as asthma and rhinitis, and the symptoms of chemical sensitivity. Most commonly, however, localised symptoms result, on the genitals, anus and surrounding skin and tissues, plus urinary symptoms and, for women, inflammation or pain in the pelvic region. Dermatitis can also be connected to sexual activity, especially around the mouth, neck, lower face and upper thighs.

There are three main categories of causes. The first, and most common, is chemicals used by you or your partner as toiletries, personal hygiene, or cosmetics; as laundry agents; or on products such as sanitary towels, tampons or incontinence protection. You may be sensitive to things that you use, or that your partner has used. They may be things that you tolerate well unless you have contact in an intimate area. Sweat and friction increase the likelihood of reaction – they make the skin and tissues more permeable and more likely to absorb chemicals. So, for instance, a soap powder or deodorant that normally does not bother you, may make you react where you have intimate contact.

Drugs or ointments that you are taking to treat these symptoms, or some other condition, can also cause genitourinary symptoms. Take medical advice on whether to discontinue these.

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