It is suggested that sterilization requires grieving. All sterilization involves a loss – a loss of fertility. Though it may be by vasectomy or tubal ligation or naturally, as at the menopause, it is not necessarily welcomed. Mr G. was left numb and empty after the procedure. It was not acceptable for him to be angry with his wife for pushing him to do it. Although there was some camaraderie and group support in ‘joining the club’, he needed help to see why he went off sex and is only now enjoying it again two years later.
What features of the grief reaction should be expected. Emptiness, denial, anger and later readjustment to a world that will never be the same. This is not a time to hand over control on the spur of the moment. Doctors are sometimes asked by a partner to arrange vasectomy for the spouse. It is essential to determine how the request has come about; perhaps interviewing the man alone. Doctors may be asked for advice when a choice for a vasectomy or tubal ligation seems even handed. An important parameter to consider is to identify who would grieve least from losing their fertility.
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Nowadays, with a national cervical screening programme in place, someone like Mrs H. may not manage to avoid a smear for so long, but she would certainly have managed to find some effective way of keeping both doctors and her husband away from her emotional fears surrounding intercourse until she wanted a baby: if not away from the actual physical examination, as had happened here. The patient has to want some changes to be made before treatment can begin to be effective, but Mrs H. could not acknowledge her own desire to have intercourse and all that it might mean for her. However, now it was for a baby she felt that it was a suitably acceptable reason to approach her doctor about such an uncomfortable topic.
It took Mr and Mrs H. almost a year to achieve intercourse and there followed 18 months of infertility before the psychosexual doctor met them again, this time in the infertility clinic. Mrs H. had changed into a confident woman compared with the little girl that had appeared originally. A simple ovulation induction regime proved successful and they now have a healthy young son.
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These terms are often used interchangeably. Unplanned may also mean unwanted. For some women, an unplanned pregnancy may be a very unwelcome intrusion into her life. For others, unplanned pregnancies may not necessarily be unwanted. It is estimated that up to one third of pregnancies may be unplanned (Fleissig, 1991). Some women may go on to term because of moral objections to abortion, but some of these unplanned pregnancies do become very much wanted. Efficient contraception is meant to lead to ‘family planning’ but we all know plenty of women who look lovingly at their bulging abdomen and say, ‘It wasn’t planned’ Efficient contraception means being able to take responsibility for deciding when to have a baby. To some this means waiting for the right situation in terms of marriage, accommodation, money and career. It also means being able to say to the world that they are now mature enough to become a parent and responsible enough to care for another individual. Some women can allow themselves to have a baby in less than ideal circumstances only by allowing it to be unplanned.
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It is common for the coil (intrauterine contraceptive device, or IUCD) to be chosen by the woman after all other methods have been discussed and rejected, for whatever reason. All doctors are familiar with the lady who, sitting back in her chair, looks with a marked lack of enthusiasm at the tiny curl of plastic and copper, and says, dubiously, ‘Well, I could give it a go.’ By this time, the doctor, for medico-legal reasons, has gone into gruesome detail about possible, horrific sounding side-effects, so it is surprising that women choose it at all. The next, inevitable question is ‘Will it hurt?’ In other words, the woman is accepting that here she is placing herself directly in thedoctor’shands, and is prepared to suffer the pain, vulnerability and humiliation of having a foreign body inserted into her precious womb. What can this method mean?
It is sometimes considered that this is a passive response by the woman, placing the responsibility onto the doctor. It has to be said that, as far as this doctor is concerned, such a feeling is rare. This author is usually more aware of admiration for the sheer courage of a woman prepared to undergo this experience. Why should she choose this method?
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Thus to use contraception requires at some level a grieving for all the possible loved babies that could be born. We are all too aware of the terrible irony of couples assiduously and conscientiously using contraception for years, only to discover that one or other or both of them are infertile. An awareness of these often unspoken feelings may explain some of the enormous fear of the reliable methods of contraception that can underlie some contraceptive difficulties. Such methods are too powerful and will damage fertility. There is a fear of retribution, the woman will be unable to have children, and hence some will play contraceptive roulette in order to ‘placate the gods’.
The reality, of course, has been that human beings from earliest historical times have tried to control their fertility when it was inconvenient to have a child. The sin of Onan in the Old Testament exemplifies this. Onan should under Hebraic law have impregnated his dead brother’s wife. Instead he ‘cast his seed upon the ground’ angering God. This story has been used as evidence that all forms of non-reproductive sex and the use of contraception are against God’s will. The ancient Egyptians used a vaginal pessary made of crocodile dung to prevent conception, and instruments to procure abortion were used in Roman times. Hippocrates, the father of medicine, advocated violent exercises. Thus powerful opposing forces are present in our psyches, both the urge to reproduce but also the urge to abort. All this may seem a far cry from the ordinary contraceptive consultation but every now and then these forces will be evident.
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Steroids are very powerful and potentially dangerous drugs which are used to prevent the inflammatory reactions that accompany allergic reactions. They are used particularly in more serious cases and are very effective.
For serious conditions, steroids may need to be taken for long periods at higher dosages, with the risk of inducing side effects which may not be readily reversible. If you have an alternative, such as avoiding the substances or foods which are triggering the disease, this is clearly better. If there is no alternative, then it is necessary to weigh up the advantages of the steroids against their risks. Ask your doctor to discuss it with you openly, so that you can make an informed decision. If you have serious disease or disability, do not refuse steroids without understanding the consequences.
Steroids should not be stopped suddenly if they have been taken for more than a few days, because they depress the natural production of steroids by the body, which must be given a chance to recover.
The worst side effects of steroids are mostly associated with prolonged oral treatments, or repeated injections, though if you use steroid creams or ointments too lavishly (particularly the stronger ones) you can absorb enough to have general effects. Side effects include facial swelling, obesity, brittle bones, high blood pressure, cataracts, diabetes, peptic ulceration, changes in mental state, and slowing the growth of children. Local effects include thinning of the skin and mucus membrane, nosebleeds, and reduced resistance to infections.
Very few people experience side effects from short courses of steroids or from the regular use of steroid inhalers, and this is the treatment of choice for moderate or severe asthma which cannot be controlled by avoiding allergens or other triggers.
Steroid inhalers (e.g. Becotide, Becloforte, Pulmicort) have less side effects than using tablets. (Sodium cromoglycate inhalers, see above, are usually tried before steroids because they can be effective, particularly with allergic asthma.) As a side effect, steroid inhalers can cause candidiasis (thrush) in the throat. This can be reduced by using a spacer, or by gargling with water after each use.
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If the above is not sufficient to relieve symptoms, then you may have to take greater precautions and limit your exposure to water generally as in the detection programme above. Try any or all of those avoidance measures and see how far you need to go.
If you are exceptionally sensitive, it may be worthwhile installing a plumbed-in filtering system of some kind (see below). Some people also find it helps to use a bottled water for cooking, washing vegetables and brushing teeth, although this is costly and inconvenient. Filtered or purified water is cheaper in the long run.
Some people are very sensitive to the fumes of water when it first emerges from the tap or cistern. If this applies to you, try the following measures. Start the bath or basin filling, then leave the room while they fill, with the window open to ventilate. Return and turn off the taps. Leave the room again and leave the water to stand for a few minutes more if you need to. Avoid taking showers. The fumes are more concentrated in newly emerging water. Get someone to flush the lavatory for you, if you can. Keep the lid shut as it flushes.
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If you are very chemically sensitive, you are best advised not to buy, use or travel in a brand new car. These usually give off high levels of chemical fumes and vapours from new foam, plastics and materials, particularly for the first six months. Many chemically sensitive people will be fine in a new car after six months. Some who are much more sensitive find they can only travel comfortably in a car which is at least two or three years old.
If you are thinking of buying a car, test-drive models and makes of different ages, or travel in friends’ or family’s cars, to see which age of car suits you best. If you ever have to hire a car, ask for one which is of an age that you tolerate well.
Some models and makes of car have fascia, seats and fittings made of materials which are better-tolerated by some people. The Volvo 340 range and the Volkswagen Polo, for instance, seem to be made of different materials; some people feel better in these, although others notice no difference. The Citroen 2CV and Dyane range have very little plastic fascia, and also cause fewer problems. Some people tolerate leather seats better than those of synthetic materials. Again, test-drive or try out different models or makes to see if one suits you better.
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Hard lenses do not absorb fluid in the way that soft lenses do. Even in gas-permeable lenses, only a tiny amount of fluid is taken up by the lens. Preservative-based systems can therefore be used on hard lenses without trouble by the chemically sensitive, since the agent can be thoroughly rinsed off before wearing.
The rinsing solution used is a sterile saline solution sold in ozone-friendly aerosol cans. Some brands of saline are buffered with chemicals that maintain the pH of the solution; these can cause problems. Make sure you are using an unbuffered saline solution – there are half a dozen brands readily available. Ask your optician or pharmacist to check for you if you are not sure which to use.
If you use a surfactant cleaner for your hard lenses, these will be thoroughly removed by overnight soaking and rinsing in saline.
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Burns and Scalds
Cool the area of the burn or scald to relieve pain. Keep the burned area in cold water or hold it under a cold running tap until the pain stops, or for at least 10 minutes. Do not prick or burst any blisters, or apply any ointment or lotion.
If the burn or scald is serious, seek emergency medical help. If the bum or scald is superficial, but rubs against clothing, cover it with a dressing of pure cotton lint and secure it with a cotton bandage. Do not use fluffy cotton wool.
Cystitis
Drinking alkali salts can ease the symptoms of cystitis. Dissolve a teaspoon of sodium bicarbonate in a glass of water and drink it. Consult your doctor if you are on a low-salt diet.
Diarrhoea
Taking arrowroot will stop diarrhoea very effectively. You can buy this as a powder at a pharmacy and make a paste by adding water. Consult your pharmacist to get the right dosage.
If you need rehydration salts after severe diarrhoea, do not take any of the proprietary ready-mixed products which can cause reactions. Rehydration salts are a mixture of sodium and potassium salts, and glucose in the right ratio; ask a pharmacist to mix these for you.
Earache
If you tolerate olive oil, warm a teaspoonful of it. Drop it into the ear, then close the earhole with pure cotton wool.
An alternative to this is sodium bicarbonate BPC, which is available in an eardrop solution.
Eyewash
For sore and itchy eyes, use a sterile saline solution to ease the itchiness. Either make a solution yourself, buy Normasol or Steripod in sachets from a pharmacist. Bathe the eyes with the solution in an eyebath, or put a few drops into the eye with a dropper.
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